Bismuth preparation

Bismuth subsahcylate [14882-18-9] Pepto-Bismol, is a basic salt of varying composition, corresponding approximately to i9-H0CgH4C02(Bi0). Like a number of other insoluble bismuth preparations, it is not currentiy approved in the United States for the treatment of peptic ulcer disease but is under active investigation for this purpose (180). It does appear to be effective for the rehef of mild diarrhea and for the prevention of travelers diarrhea (181). The ready availabiUty of this dmg, however, may lead to its ovemse and result in toxic effects caused by both the saUcylate and bismuth components. It has been suggested that bismuth subsahcylate is somewhat effective in the symptomatic treatment of isosporiasis, a disease caused by the intracellular parasite Isospora belli (182). 

In postwar France, the Berthier Pharmaceutical Company in Grenoble began to pursue a sideline project of producing soothing liquid bismuth preparations for acute tonsillitis. Being dissatisfied with the commonly used oils, they elected to use the supposedly... 

Preparation. Prepare bismuth by reducing a solution of its salt with zinc and test the reaction of the bismuth prepared with acids. Under what conditions can bismuth be prepared from its compounds by using tin(II) compounds as the reducing agent Write the equations of the reactions. 

See how the bismuth prepared reacts with dilute and concentrated hydrochloric, sulphuric, and nitric acids. 

Colloidal bismuth Preparations of this compound effectively heal peptic ulcers. In addition to their antimicrobial actions (see p. 236), they inhibit the activity of pepsin, increase mucus secretion and interact with proteins in necrotic mucosal tissue to coat and protect the ulcer crater. 

When solutions of lead or bismuth salts are treated with alkali hypo-bromite, lead peroxide and higher oxides of bismuth are formed. These products react with benzidine acetate to give benzidine blue (seepage 282). However, if bismuth salts are heated alone with alkali hydroxides, a yellow precipitate forms, [probably BiO(OH)] and, when once formed, is not converted into higher bismuth oxides on treatment with h3q)obromite. This resistance is applied in the detection of lead in bismuth salts. The following procedure is recommended in the examination of pharmaceutical bismuth preparations (e.g., bismuth sub-gallate, -tannate, -salicylate). 

Malfertheiner P, Nilius M Bismuth preparations. In CS Goodwin, BW Worsley (eds) Helicobacter pylori biology and clinical practice. CRC Press, Boca Raton. 1993 351-364... 

Two questions are still unresolved (1) in which way does bismuth induce encephalopathy, and (2) why did bismuth encephalopathy only recently develop suddenly in so many patients whereas bismuth preparations had been in general used for decades ... 

The use of high-dose bismuth preparations is a national and regional phenomenon — e.g. much use is made of these products in France. In the Netherlands on the other hand the recommended daily dose of bismuth (mainly subnitrate) does not exceed at the most 3 g. So far no cases have been reported in that country. However, Hazemann et al. described encephalopathy in 2 patients who used only 4 g bismuth subnitrate daily (14 ). The more alarming is the fact that one of these patients apparently had been using the drug for only 1 or 2 months. 

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