Bismuth Subsalicylate Coagulopathy in a Patient with Chronic Liver Disease

Catherine Yu, Noel Eustaquio, Diane P. Calello, Bruce E. Ruck, Lewis S. Nelson, Cynthia Santos

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Bismuth subsalicylate (BSS) is the active ingredient in over-the-counter antacid and antidiarrheal medications. Coagulopathy in the setting of acetylsalicylic acid toxicity is well documented but not in setting of bismuth subsalicylate overuse. We present a case report of coagulopathy from BSS poisoning in a patient with underlying cirrhosis. The patient’s high prothrombin time suggests inhibition of vitamin K-dependent coagulation factors. The patient had decreased factor V activity, which is responsible for converting prothrombin to thrombin. Patients with cirrhosis often have hypoprothrombinemia which may be exacerbated by salicylate-induced coagulopathy. Given the widespread use of BSS products, physicians should recognize coagulopathy as a possible manifestation of toxicity especially in patients with underlying liver disease.

Original languageEnglish (US)
Pages (from-to)198-201
Number of pages4
JournalJournal of Medical Toxicology
Issue number3
StatePublished - Jul 15 2019

All Science Journal Classification (ASJC) codes

  • Toxicology
  • Health, Toxicology and Mutagenesis


  • Bismuth
  • Coagulopathy
  • Liver disease
  • Salicylate


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