Which statement about bismuth subsalicylate is true?

• A. Black tongue and dark stools are expected effects.
• B. It commonly causes severe hepatotoxicity.
• C. It frequently leads to GI bleeding.
• D. It requires urgent medical evaluation for all patients.

Answer: (A)

Bismuth subsalicylate frequently causes harmless darkening of the tongue and stools. This color change happens because bismuth reacts to form a dark bismuth sulfide compound that can tint saliva and stool; it’s an expected, cosmetic effect and not a sign of pathology. The other statements aren’t characteristic of this medication’s safety profile: it does not commonly cause hepatotoxicity or GI bleeding, and for most patients, urgent medical evaluation isn’t required solely because of its use. (Note that, since it contains a salicylate, it should be used with caution in children or teens with viral illnesses due to the risk of Reye syndrome, and in high doses can lead to salicylate toxicity, but these are not typical outcomes in normal use.)