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The New England Journal of MedicineBismuth Subsalicylate Poisoning

She has been treating her IBS with bismuth subsalicylate. Her symptoms include shortness of breath, nausea, and vomiting. On exam, the patient is confused. Laboratory testing showed primary anion-gap metabolic acidosis, primary respiratory alkalosis, and a salicylate level 25x greater than the normal upper limit.

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