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This educational activity focuses on bismuth subsalicylate's applications in managing gastrointestinal discomfort and traveler's diarrhea. The drug's mechanism of action, potential adverse reactions, and contraindications will be discussed. By also exploring bismuth subsalicylate's pharmacokinetics, optimal administration methods, and necessary monitoring protocols, this program aims to enhance professionals' proficiency in clinical toxicology related to the medication. The goal of this program is to furnish healthcare professionals with the requisite expertise to administer bismuth subsalicylate optimally. By providing evidence-based information, this discussion facilitates informed decision-making, enabling practitioners to tailor treatment strategies to individual patient needs. By understanding bismuth subsalicylate's intricacies, healthcare professionals can mitigate adverse reactions, optimize dosages, and deliver precise, safe, and individualized care. Objectives: Evaluate the mechanism of action of bismuth subsalicylate. Assess the potential adverse effects of bismuth subsalicylate. Identify the appropriate monitoring for patients using bismuth subsalicylate. Implement effective collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients who might benefit from bismuth subsalicylate therapy. Access free multiple choice questions on this topic.

The most concerning adverse effect of bismuth subsalicylate (BSS) is salicylate toxicity, which can rarely occur. This toxicity primarily occurs in patients who have taken bismuth subsalicylate inappropriately, whether through an overdose or for extended periods.[32] Symptoms of bismuth toxicity include impaired cognition, tremors, lethargy, somnolence, insomnia, delirium, myoclonus, seizures, depressed mood, anxiety, and a depressed mood.[33] If a patient is experiencing bismuth toxicity, they should discontinue BSS use and seek medical attention. There is little evidence to suggest that bismuth subsalicylate can be fatal, although there have been a few reported cases.[31] Toxicity is generally reported in patients who ingest more than 150 mg/kg of salicylates (or >6.5 g of aspirin equivalent). There are no specific antidotes for salicylate toxicity. However, managing mild-to-moderate toxicity generally includes supportive care with intravenous fluids. If the patient presents within 2 hours of ingesting BSS, decontamination with activated charcoal is strongly recommended. Salicylate absorption can be delayed; activated charcoal may be administered beyond 2 hours post-ingestion if the patient is in a normal mental state. Checking the patient's salicylate concentration every 1 to 2 hours is recommended until a decline is observed. The healthcare team should consider urine alkalization if the salicylate concentration exceeds 30 mg/dL. In more severe cases and with the presence of altered mental status and metabolic acidosis, hemodialysis may be considered. If the patient cannot maintain their airway and intubation is required, precautions should be taken to avoid severe acidosis. Close follow-up with arterial blood gases and maintaining the pre-intubation minute ventilation and a low PCO2 level is recommended. Other laboratory parameters recommended to be collected include a hepatic panel, INR/PTT, CBC, electrolytes, and serum creatinine (renal function).

Bismuth subsalicylate (BSS) is an over-the-counter (OTC) product in the United States.[28] Even though this medication is available without a prescription, the interprofessional healthcare team needs to be aware of the proper use of BSS and coordinate care to educate patients and monitor both efficacy and toxicity. Pharmacists can identify any drug-drug interactions with BSS and recommend the findings to both providers and patients. Clinicians, nurses, and pharmacists can play a significant role in educating patients about the proper use of BSS and informing the patient about common adverse effects. For example, patients should be aware that the darkening of the stool or tongue using BSS is temporary and harmless. However, patients should contact a healthcare provider before ingesting BSS if they develop a fever or mucus in the stool. Patients should discontinue the use of BSS if: Their symptoms last for more than 14 days Their symptoms worsen Their diarrhea does not improve after 2 days of use They develop a fever They experience hearing loss or tinnitus [17] Finally, when toxicity is suspected, a consult with a clinical toxicologist or a poison control center is encouraged to help manage the patient's condition appropriately.