Bismuth toxicity - Revision history

Elcatracho: /* Management */

2021-03-08T21:51:00Z

Management

← Older revision		Revision as of 21:51, 8 March 2021
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	**Limited data to support its use		**Limited data to support its use
	**Exact timing and dosages are unknown		**Exact timing and dosages are unknown
	**~~British anti-Lewisite~~ (BAL)		**[[Dimercaprol]] (BAL)
	***Undergoes biliary elimination which is useful in those with renal insufficiency		***Undergoes biliary elimination which is useful in those with renal insufficiency
	***Benefits shown in experimental models		***Benefits shown in experimental models

Elcatracho: /* Disposition */

2021-03-08T21:46:07Z

Disposition

← Older revision		Revision as of 21:46, 8 March 2021
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	*Admission if evidence of renal failure or encephalopathy manifestations		*Admission if evidence of renal failure or encephalopathy manifestations
	*Consult Toxicology or [[poison control]]		*Consult Toxicology or [[poison control]]

			==See Also==
			*[[Toxicology (main)]]

	==References==		==References==

Elcatracho: /* Evaluation */

2021-03-08T21:45:13Z

Evaluation

← Older revision		Revision as of 21:45, 8 March 2021
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	*CT head for cases of encephalopathy		*CT head for cases of encephalopathy
	**May show diffuse cortical hyperdensity of the grey matter		**May show diffuse cortical hyperdensity of the grey matter
	*Salicylate level		*[[Salicylate]] level
	**In the United States bismuth subsalicylate is the most common oral compound, and up to 90% of salicylate is absorbed <ref>Pickering LK, Feldman S, Ericsson CD, Cleary TG. Absorption of salicylate and bismuth from a bismuth subsalicylate containing compound (Pepto- Bismol). J Pediatr. 1981;99:654-656.</ref>		**In the United States [[bismuth subsalicylate]] is the most common oral compound, and up to 90% of salicylate is absorbed <ref>Pickering LK, Feldman S, Ericsson CD, Cleary TG. Absorption of salicylate and bismuth from a bismuth subsalicylate containing compound (Pepto- Bismol). J Pediatr. 1981;99:654-656.</ref>
	*EEG		*EEG

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

2018-10-21T00:27:45Z

Text replacement - "*UA" to "*Urinalysis"

← Older revision		Revision as of 00:27, 21 October 2018
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	*BMP		*BMP
	*CBC		*CBC
	*UA		*[[Urinalysis]]
	*CT head for cases of encephalopathy		*CT head for cases of encephalopathy
	**May show diffuse cortical hyperdensity of the grey matter		**May show diffuse cortical hyperdensity of the grey matter

Rossdonaldson1: Text replacement - "Poison Control Center" to "poison control"

2018-08-13T21:26:25Z

Text replacement - "Poison Control Center" to "poison control"

← Older revision		Revision as of 21:26, 13 August 2018
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	==Disposition==		==Disposition==
	*Admission if evidence of renal failure or encephalopathy manifestations		*Admission if evidence of renal failure or encephalopathy manifestations
	*Consult Toxicology or ~~Poison Control Center~~		*Consult Toxicology or [[poison control]]

	==References==		==References==

Rossdonaldson1: /* Clinical Features */

2018-08-12T21:21:52Z

Clinical Features

← Older revision		Revision as of 21:21, 12 August 2018
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	==Clinical Features==		==Clinical Features==
	*'''Acute~~'''~~		===Acute===
	**Abdominal pain		*[[Abdominal pain]]
	**Oliguria		*Oliguria
	**Acute tubular necrosis and renal failure		*Acute tubular necrosis and renal failure
	*'''Chronic~~'''~~
	**Diffuse progressive encephalopathy		===Chronic===
	**Neurobehavioral changes		*Diffuse progressive encephalopathy
	***Apathy		*Neurobehavioral changes
	***Irritability		**Apathy
	***Poor concentration		**Irritability
	***Worsened short term memory		**Poor concentration
	***Visual hallucinations		**Worsened short term memory
	**Movement disorders		**Visual hallucinations
	***Myoclonus		*Movement disorders
	***Ataxia		**Myoclonus
	***Tremors		**[[Ataxia]]
	**Pigmentation of skin and oral mucosa		**Tremors
	**Seizure		*Pigmentation of skin and oral mucosa
	**Coma and death		*[[Seizure]]
			*[[Coma]] and [[death]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1 at 20:44, 12 August 2018

2018-08-12T20:44:50Z

← Older revision		Revision as of 20:44, 12 August 2018
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	****Gastric ulcers		****Gastric ulcers
	***Cause toxicity		***Cause toxicity
	==Toxicokinetics==
			===Toxicokinetics===
	*Poorly understood due to lack of data		*Poorly understood due to lack of data
	*Low absorption in the GI tract, approximately 0.2% is systemically absorbed <ref>Hundal O, Bergseth M, Gharehnia B, et al. Absorption of bismuth from two bismuth compounds before and after healing of peptic ulcers. Hepatogastroenterology. 1999;46:2882-2886.</ref>		*Low absorption in the GI tract, approximately 0.2% is systemically absorbed <ref>Hundal O, Bergseth M, Gharehnia B, et al. Absorption of bismuth from two bismuth compounds before and after healing of peptic ulcers. Hepatogastroenterology. 1999;46:2882-2886.</ref>
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	*Levels may be increased in those taking PPI		*Levels may be increased in those taking PPI
	**Ranitidine does not alter the absorption of bismuth		**Ranitidine does not alter the absorption of bismuth

	==Clinical Features==		==Clinical Features==
	*'''Acute'''		*'''Acute'''
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	==Differential Diagnosis==		==Differential Diagnosis==
	~~===[[~~Heavy ~~metal]] toxicity===~~		{{Heavy metals list}}
	*[[Aluminum toxicity]]
	*[[Antimony toxicity]]
	*[[Arsenic toxicity]]
	*[[Barium toxicity]]
	*[[Bismuth toxicity]]
	*[[Cadmium toxicity]]
	*[[Chromium toxicity]]
	*[[Cobalt toxicity]]
	*[[Copper toxicity]]
	*[[Gold toxicity]]
	*[[Iron toxicity]]
	*[[Lead toxicity]]
	*[[Lithium toxicity]]
	*[[Manganese toxicity]]
	*[[Mercury toxicity]]
	*[[Nickel toxicity]]
	*[[Phosphorous toxicity]]
	*[[Platinum toxicity]]
	*[[Selenium toxicity]]
	*[[Silver toxicity]]
	*[[Thallium toxicity]]
	*[[Tin toxicity]]
	*[[Zinc toxicity]]
	===[[Encephalopathy]]===		===[[Encephalopathy]]===
	*[[Viral encephalopathy]]		*[[Viral encephalopathy]]
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	*[[Postanoxic encephalopathies]]		*[[Postanoxic encephalopathies]]
	*[[Progressive multifocal ataxia]]		*[[Progressive multifocal ataxia]]

	==Evaluation==		==Evaluation==
	*Need to have high index of suspicion		*Need to have high index of suspicion
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	**In the United States bismuth subsalicylate is the most common oral compound, and up to 90% of salicylate is absorbed <ref>Pickering LK, Feldman S, Ericsson CD, Cleary TG. Absorption of salicylate and bismuth from a bismuth subsalicylate containing compound (Pepto- Bismol). J Pediatr. 1981;99:654-656.</ref>		**In the United States bismuth subsalicylate is the most common oral compound, and up to 90% of salicylate is absorbed <ref>Pickering LK, Feldman S, Ericsson CD, Cleary TG. Absorption of salicylate and bismuth from a bismuth subsalicylate containing compound (Pepto- Bismol). J Pediatr. 1981;99:654-656.</ref>
	*EEG		*EEG

	==Management==		==Management==
	*Supportive care		*Supportive care

Therriac at 00:37, 8 August 2018

2018-08-08T00:37:13Z

← Older revision		Revision as of 00:37, 8 August 2018
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	<references/>		<references/>
	Rao, R. Bismuth. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1233-1236		Rao, R. Bismuth. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1233-1236

			[[Category:Toxicology]]

Therriac: Created page with "==Background== Heavy Metal Available in two forms Elemental Nontoxic Bismuth Salts Uses **Oral preparations for traveler's diarrhea, nausea, and vomiting *..."

2018-08-02T21:16:26Z

Created page with "==Background== *Heavy Metal *Available in two forms **Elemental ***Nontoxic **Bismuth Salts ***Uses ****Oral preparations for traveler's diarrhea, nausea, and vomiting ***..."

New page

==Background==
*[[Heavy Metal]]
*Available in two forms
**Elemental
***Nontoxic
**Bismuth Salts
***Uses
****Oral preparations for traveler's diarrhea, nausea, and vomiting
****Bismuth-impregnated surgical packing pastes for ileostomies and colostomies
****Gastric ulcers
***Cause toxicity
==Toxicokinetics==
*Poorly understood due to lack of data
*Low absorption in the GI tract, approximately 0.2% is systemically absorbed <ref>Hundal O, Bergseth M, Gharehnia B, et al. Absorption of bismuth from two bismuth compounds before and after healing of peptic ulcers. Hepatogastroenterology. 1999;46:2882-2886.</ref>
*90% excreted from kidneys
*Levels may be increased in those taking PPI
**Ranitidine does not alter the absorption of bismuth
==Clinical Features==
*'''Acute'''
**Abdominal pain
**Oliguria
**Acute tubular necrosis and renal failure
*'''Chronic'''
**Diffuse progressive encephalopathy
**Neurobehavioral changes
***Apathy
***Irritability
***Poor concentration
***Worsened short term memory
***Visual hallucinations
**Movement disorders
***Myoclonus
***Ataxia
***Tremors
**Pigmentation of skin and oral mucosa
**Seizure
**Coma and death

==Differential Diagnosis==
===[[Heavy metal]] toxicity===
*[[Aluminum toxicity]]
*[[Antimony toxicity]]
*[[Arsenic toxicity]]
*[[Barium toxicity]]
*[[Bismuth toxicity]]
*[[Cadmium toxicity]]
*[[Chromium toxicity]]
*[[Cobalt toxicity]]
*[[Copper toxicity]]
*[[Gold toxicity]]
*[[Iron toxicity]]
*[[Lead toxicity]]
*[[Lithium toxicity]]
*[[Manganese toxicity]]
*[[Mercury toxicity]]
*[[Nickel toxicity]]
*[[Phosphorous toxicity]]
*[[Platinum toxicity]]
*[[Selenium toxicity]]
*[[Silver toxicity]]
*[[Thallium toxicity]]
*[[Tin toxicity]]
*[[Zinc toxicity]]
===[[Encephalopathy]]===
*[[Viral encephalopathy]]
*[[Ethanol withdrawal]]
*[[Creutzfeld-Jacob disease]]
*[[Lithium toxicity]]
*[[Neurodegenerative leukoencephalopathies]]
*[[Nonketotic hyperosmolar coma]]
*[[Postanoxic encephalopathies]]
*[[Progressive multifocal ataxia]]
==Evaluation==
*Need to have high index of suspicion
*BMP
*CBC
*UA
*CT head for cases of encephalopathy
**May show diffuse cortical hyperdensity of the grey matter
*Salicylate level
**In the United States bismuth subsalicylate is the most common oral compound, and up to 90% of salicylate is absorbed <ref>Pickering LK, Feldman S, Ericsson CD, Cleary TG. Absorption of salicylate and bismuth from a bismuth subsalicylate containing compound (Pepto- Bismol). J Pediatr. 1981;99:654-656.</ref>
*EEG
==Management==
*Supportive care
*Consider whole bowel irrigation
*Chelation
**Limited data to support its use
**Exact timing and dosages are unknown
**British anti-Lewisite (BAL)
***Undergoes biliary elimination which is useful in those with renal insufficiency
***Benefits shown in experimental models

==Disposition==
*Admission if evidence of renal failure or encephalopathy manifestations
*Consult Toxicology or Poison Control Center

==References==
<references/>
Rao, R. Bismuth. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1233-1236