Work

Bismuth toxicity: a rare cause of non-convulsive status epilepticus

Year: 2025

Type: article

Abstract: Introduction Bismuth is a heavy metal that is used for therapeutic purposes including over the counter formulations. Here we describe a case of status epilepticus related to bismuth toxicity.Case report A 77-year-old woman had witnessed seizures at home which continued as status epilepticus in the hospital. Neuroimaging did not reveal a cause of seizures, which continued despite correction of various metabolic derangements. Lumbar puncture later did not reveal signs of infection. She eventually required numerous antiepileptic agents to maintain burst suppression. Bismuth concentrations were elevated in the urine (5800 mcg/L) and cerebrospinal fluid (1.8 mcg/L).Discussion Status epilepticus is a neurologic emergency that requires hospitalization with a variety of potential causes including bismuth intoxication. Recent initiation of bismuth subsalicylate and high concentrations in the urine and cerebrospinal fluid support bismuth toxicity as the cause of refractory status epilepticus in this patient.

Source: Toxicology Communications

DOI: 10.1080/24734306.2025.2492977

Authors: Tyler Maggio, Nancy Mikati, Boulos Nassar, Marielle Brenner, Daniel McCabe

Institutions: University of Iowa Health Care, University of Iowa Hospitals and Clinics

Language: English

Topic: Heavy Metal Exposure and Toxicity

Subfield: Health, Toxicology and Mutagenesis

Field: Environmental Science

Domain: Physical Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $778