Bismuth intoxication

The effects of acute bismuth intoxication include gastrointestinal disturbance, anorexia, headache, malaise, skin reactions, discolouration of the mucous membranes and mild jaundice.244... 

Bismuth compounds are used as an antidiarrheal. Topical applications are used in skin disorders. Overdose may cause acute bismuth intoxication but gastric lavage, purgation, use of chelating agents, 2,3-dimercapto-l-propane sulfonic acid, and hemodialysis are steps to be taken.170-172... 

Cellular and molecular mechanisms of neurotoxicity are also influenced by the fact that neurons are postmitotic and do not divide. Thus, the capacity for replacement of damaged cells does not exist in the nervous system, whereas most other organ systems have a well-established capacity for regeneration. Many neurotoxins can cause encephalopathy and an important concept in neurotoxicology is the delayed manifestation of symptoms sometimes up to years after the exposure started. Several agents show a lag time between exposure and neurotoxicity. Examples are the organophosphate chemical warfare agents [245], bismuth intoxications [246] and methylmercury... 

Basinger MA, Jones MM and MgCroskey SA (1983) Antidotes for acute bismuth intoxication. 

It is indicated in metallic intoxication due to arsenic, mercury, gold, bismuth, lead, nickel, thallium and antimony in conjunction with sodium calcium edetate for lead poisoning. It is also useful in hepatolenticular degeneration (Wilson s disease). It is contraindicated in iron and cadmium poisoning. 

Mellario, F., Commln, P., Bismuth, C. and Gaultier, M. 1979 L electro-encephalographle au cours du traltement par eserlne des Intoxications antlchollnerglques. Rev. EEG Neurophysiol. 

Conso F, Bismuth C, Riboulet G, Efthymiou ML. Intoxication aigue par I ajmaline. [Acute poisoning by ajmaline.] Therapie 1979 34(4) 529-30. 

Severe systemic intoxication in the past has been observed after incautious use of bismuth salts on extensive wound areas. 

A 22-year-old woman took 5.4g of colloidal bismnth subcitrate in a suicide attempt and developed Fanconi s syndrome and acute renal insufficiency (35). She received hemodialysis and intravenons sodinm 2,3-mercapto-l-propanesulfonate 60 hours after intoxication. Her semm bismuth concentrations fell from 640 to 15 pg/l within 6 days, her renal function improved, and her tonsillar nlceration healed. Hemodialysis was discontinned on day 14. She had normal renal fnnction 6 weeks later. 

Slikkerveer A, De Wolff FA. Bismuth Biokinetics and neurotoxicity. Vinken PJ, Bruyn GW, editors. Handbook of Clinical Neurology. Vol. 64. Intoxication of the Nervous System. Part I. Amsterdam Elsevier, 1994 331-51. 

Martin-Bouyer G. Intoxications par les sels de bismuth administres par voie orale. [Poisoning by orally administered bismuth salts.] Gastroenterol Clin Biol 1978 2(4) 349-56. 

Hruz P, Mayr M, Low R, Drewe J, Huber G. Fanconi s syndrome, acute renal failure, and tonsil ulcerations after colloidal bismuth subcitrate intoxication. Am J Kidney Dis 2002 39(3) E18. 

J. J. Berzelius in 1814. Bismuth occurs less rarely than mercury, but shows a more frequency of appearance as silver. It is found in its native form, and also in minerals such as bismuthite (bismuth sulfide) and bismite (bismuth oxide). The main use of bismuth is in pharmaceuticals and in low-melting point alloys which are used as fuses ( 4000 tons annually). Occupational intoxication by these alloys are rare, and in most instances the adverse effect is caused by other metals present in the alloys such as lead and cadmium. Bismuth as a metal is classed as nontoxic. 

Although metallic bismuth is used in industry in different alloys, occupational intoxications by these alloys are rare and, in most instances, are caused by the presence of other metals such as lead or cadmium. In this respect, it might be concluded that bismuth toxicity in an industrial setting is nonexistent (Fowler and Vouk 1986). 

Salicylates are widely used for their analgesic and anti-inflammatory properties. They are found in a variety of prescription and over-the-counter analgesics, cold preparations, and topical keratolytic products (methyl salicylate), and even Pepto-Bismol (bismuth subsalicylate). Eiefore the introduction of child-resistant containers, aspirin overdose was one of the leading causes of accidental death in children. Two distinct syndromes of intoxication may occur, depending on whether the exposure is acute or chronic. 

Toxicity in industry does not exist [3,4]. All lethal intoxications are attributed to therapeutic uses of bismuth compounds, mostly injections or long-lasting treatments. Reports in the 1970s from Australia and France about serious intoxications induced by bismuth led to an important reduction of its medical use. In the 1980s some bismuth compounds were successfully tested in the treatment of chronic gastritis without the former side effects. Nevertheless single cases of poisonings were also reported in the last years [35-37]. It appears that bismuth is not an essential element [4,7]. 

Heavy metals used to cause chronic diseases, often deposited along the marginal gingiva. Improved work safety standards have made these types of chronic intoxication rare in the industrialized world but, in earlier times, lead, silver, bismuth, tin and cadmium caused oral problems. The discoloration may result from either metallic deposition within the skin itself or stimulation of melanin synthesis (Bleehen et al. 1992). 

Gaultier, M., Bismuth, C., Morel-Maroger, M. and Dauchy, F. (1974) Nephropathie tubulo-interstitielle aigue au cours d intoxications par la glafenine. A propos de 5 cas. Therapie, 29, 579. 

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