BIPP madness; an iatrogenic cause of acute confusion.

An 81-year-old man, admitted under the Ear, Nose and Throat Team with persistent epistaxis, developed an acute confusional state. He was previously physically independent and mentally competent. Immediate investigations did not reveal a cause for his deterioration. He eventually made a full recovery and returned home. Subsequently, his serum bismuth level was noted to be within the toxic range and was felt to have been the cause of his confusional state.