An elderly woman’s self-treatment for IBS leads to altered mental status and a mixed acid-base disorder. Discover the surprising over-the-counter cause.
A 70-year-old woman with depression and irritable bowel syndrome presented to the emergency department with a 3-day history of altered mental status, shortness of breath, nausea, and vomiting. She had recently been self-medicating worsening irritable bowel symptoms. Physical examination was notable for a respiratory rate of 22 breaths per minute, confusion, and mild, diffuse abdominal pain. Laboratory testing showed primary anion-gap metabolic acidosis and primary respiratory alkalosis. Toxicity of which of the following is the most likely cause of her acute symptoms and the findings seen in this non-contrast abdominal radiograph?
What is the most likely diagnosis?
Bismuth Salicylate, Metabolic Acidosis, Radiopaque, Salicylate Toxicity, Toxicology
