Abstract
A 68 year old man with a creatinine clearance rate of only 15 ml/min took twice the recommended dose of tripotassium dicitrato bismuthate (TDB) as DeNol liquid; 10 ml qds; a total of 864 mg bismuth daily for two months. Whole blood bismuth concentrations rose to 880 micrograms/l and he developed global cerebral dysfunction with hallucinations, ataxia, and an abnormal EEG. Renal clearance of bismuth rose from 0.24 to 2.4 ml/min when the heavy metal chelator 2-3 dimercapto-1 propane sulphonic acid (DMPS) was given by mouth. Bismuth was measured by a novel method involving inductively coupled plasma source mass spectrometry. Fifty days after stopping TDB, whole blood bismuth concentrations fell to 46 micrograms/l and the patient's EEG returned to normal. His mental function also recovered completely. The case serves as a timely reminder that TDB should not be administered to patients with renal disorders, as stated in the data sheet.
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Selected References
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- Aposhian H. V. DMSA and DMPS--water soluble antidotes for heavy metal poisoning. Annu Rev Pharmacol Toxicol. 1983;23:193–215. doi: 10.1146/annurev.pa.23.040183.001205. [DOI] [PubMed] [Google Scholar]
- Konturek S. J., Radecki T., Piastucki I., Drozdowicz D. Studies on the gastroprotective and ulcer-healing effects of colloidal bismuth subcitrate. Digestion. 1987;37 (Suppl 2):8–15. doi: 10.1159/000199553. [DOI] [PubMed] [Google Scholar]
- Martin-Bouyer G., Foulon B., Guerbois H., Barin C. Aspects épidémiologiques des encéphalopathies après administration de bismuth par voie orale. Therapie. 1980 May-Jun;35(3):307–313. [PubMed] [Google Scholar]
- Martin D. F., Hollanders D., May S. J., Ravenscroft M. M., Tweedle D. E., Miller J. P. Difference in relapse rates of duodenal ulcer after healing with cimetidine or tripotassium dicitrato bismuthate. Lancet. 1981 Jan 3;1(8210):7–10. doi: 10.1016/s0140-6736(81)90114-8. [DOI] [PubMed] [Google Scholar]
- Nwokolo C. U., Gavey C. J., Smith J. T., Pounder R. E. The absorption of bismuth from oral doses of tripotassium dicitrato bismuthate. Aliment Pharmacol Ther. 1989 Feb;3(1):29–39. doi: 10.1111/j.1365-2036.1989.tb00188.x. [DOI] [PubMed] [Google Scholar]
- Weller M. P. Neuropsychiatric symptoms following bismuth intoxication. Postgrad Med J. 1988 Apr;64(750):308–310. doi: 10.1136/pgmj.64.750.308. [DOI] [PMC free article] [PubMed] [Google Scholar]