Sampognaro Paul, Vo Kathy T, Richie Megan, Blanc Paul D, Keenan Kevin
Departments of *Neurology †Emergency Medicine §Medicine, Division of Occupational and Environmental Medicine, UCSF ‡California Poison Control System, San Francisco Division, San Francisco, CA.
Neurologist. 2017 Nov;22(6):237-240. doi: 10.1097/NRL.0000000000000144.
Bismuth salts have been used to treat gastroenterological disorders and are readily available over-the-counter and via the internet. Even though generally considered safe, bismuth compounds can cause a syndrome of subacute, progressive encephalopathy when taken in large quantities.
We present the case of woman who developed progressive encephalopathy, aphasia, myoclonus, and gait instability after chronically ingesting large amounts of bismuth subgallate purchased from a major online marketing website to control symptoms of irritable bowel syndrome. After extensive neurological work-up, elevated bismuth levels in her blood, urine, and cerebrospinal fluid confirmed the diagnosis of bismuth-related neurotoxicity. She improved slowly following cessation of exposure.
This case highlights bismuth subgallate as a neurotoxic bismuth formulation and reminds providers of the potential for safety misconceptions of positively reviewed online supplements.
铋盐已被用于治疗胃肠疾病，在非处方药店和网上都很容易买到。尽管通常被认为是安全的，但大量服用铋化合物会导致亚急性进行性脑病综合征。
我们报告一例女性病例，该患者为控制肠易激综合征症状，长期从某大型在线销售网站购买大量碱式没食子酸铋服用后，出现进行性脑病、失语、肌阵挛和步态不稳。经过全面的神经学检查，她血液、尿液和脑脊液中的铋水平升高，确诊为铋相关神经毒性。停止接触铋后，她的病情逐渐好转。
该病例突出了碱式没食子酸铋的神经毒性，并提醒医疗人员注意，网上受到好评的补充剂可能存在安全误解。
