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Discussion on Bismuth Subsalicylate Dosage

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Username: lynnebc

Post Number: 6
Registered: 9-2003
Posted on Wednesday, Jan 7, 2009 - 2:44 am:   Edit PostPrint Post

Hi Dr O
I am just wondering if any of the HA members have ever questioned the recommended dose for Bismuth Subsalicylate for adult horses as quoted in your overview on diarrhea? I am really confused since the quoted recommendation calls for a huge amount of medication, unless my calculations are completely wrong.

I am referring to the article Diarrhea in Horses, an Overview and the section on Symptomatic / Empirical Treatment for Diarrhea Not Associated with Other Disease within this overview.

Then refer to the paragraph on Bismuth Subsalicylate (eleventh bullet point) where the dose is stated as:

Adults: 1 ounce per 8 kg of body weight PO tid-qid (Clark and Becht 1987)

Taking my gelding as an example, he is about 1200 pounds = 544 kgs in weight.
544 kgs / 8 = 68 so his dose would be 68 ounces of Bismuth Subsalicylate tid-qid

To me this seems to be one heck of a lot of medication. Can the dose really be correct?

68 ounces is 4.25 pounds in weight and I have no idea how I would get that amount of a non-palatable substance into my gelding two to four times a day.

When I think of Bismuth I think of Pepto-Bismol so it would make more sense to me to give a volume (fluid) dose rather than a weight dose. However, if instead the dosage was 1 FLUID ounce per 8 kgs of body weight then that would be the equivalent of just over 2 litres of Bismuth. Again, one heck of a lot of medication.

I am wondering if the dosage was really meant to be 1 ml per 8 kg of body weight, especially since the foal dosage is given in mls (although admittedly from a different source). For my gelding that would be the equivalent of 68 mls or just over one dosing syringe full of Pepto-Bismol. This probably seems too little medication.

I would like to try Pepto-Bismol on my gelding so I would appreciate if you can confirm the dosage and clear up my confusion. If huge amounts are required then I will opt to try another of the suggested treatments in preference. The first time I can probably get one dosing syringe full of Pepto-Bismol into my horse using the surprise factor. However, if the dose is correct as stated then this is a non-starter for me as I will be coming out of the stall covered from head to toe in pink goo.

I look forward to your confirmation of dosage.
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Robert N. Oglesby DVM
Username: dro

Post Number: 22078
Registered: 1-1997
Posted on Wednesday, Jan 7, 2009 - 10:34 am:   Edit PostPrint Post

Hello Lynn
It should be noted that this recommendation is based on a 1.75% suspension which is standard for Pepto Bismol and several veterinary preparations.

1/2 gallon is a huge amount of fluid to try and get in a horse without a nasogastric tube. I went and check the newest edition of Plumb's Veterinary Pharmacology (6th edition) and this same dosage (and reference quote) is still there. I have never used this treatment and it is placed there as others (Dr Clark and Becht) have found it useful.
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Username: lynnebc

Post Number: 7
Registered: 9-2003
Posted on Wednesday, Jan 7, 2009 - 11:57 am:   Edit PostPrint Post

Hi Dr O
Thanks for taking the time to check the pharmacology and confirm the dosage of Bismuth Subsalicylate.

Since I am not very clinically inclined myself I hadn’t even thought that Drs Clark and Becht and other veterinarians would be dosing using a nasogastric tube to introduce the medication!!! The amount that I could get into my gelding using a dosing syringe would be such a drop in the ocean that I feel that I am better trying some of the other treatments first.

BTW, the overview of Diarrhea in Horses is extremely useful. I have read and re-read it several times over the past couple of weeks. It is great that you have included so many different ideas and approaches.
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