Abstract
Bismuth salts are widely used to treat peptic ulcers. Acute toxicity with colloidal bismuth subcitrate overdose causes nephrotoxicity. There have been numerous reports of encephalopathy after long-term consumption of bismuth salts, but only a few cases of nephrotoxicity (adult and pediatric) have been documented to date. This report presents a case of acute renal failure due to colloidal bismuth subcitrate overdose in adolescent. A 16-year-old girl presented with complaints of nausea, vomiting, and facial paresthesia. Ten days earlier she had tried to commit suicide by taking 60 tablets of De-nol (colloidal bismuth subcitrate 18 g). The physical examination findings on admission indicated minimal fluid overload but no signs of encephalopathy. Laboratory tests on admission showed blood urea nitrogen 102 mg/dl, serum creatinine 19.9 mg/dl, and serum bismuth level 495 µg/l. The patient was started on appropriate fluid therapy and penicillamine as a chelating agent and then began hemodialysis on alternate days. The patient’s renal function gradually returned to normal over 9 weeks and by 64 days after the overdose her serum bismuth level had fallen to almost half the level detected 2 days after admission. The patient made a complete recovery. The case demonstrates that acute renal failure can develop as a manifestation of acute toxicity from colloidal bismuth ingestion, and that the prognosis may be favorable if the patient receives appropriate supportive treatment and dialysis
References
Gorbach SL (1990) Bismuth therapy in gastrointestinal diseases. Gastroenterology 99:863–875
Wagstaff AJ, Benfield P, Monk JP (1988) Colloidal bismuth subcitrate. A review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic use in peptic ulcer disease. Drugs 36:132–157
Slikkerveer A, de Wolf FA (1989) Pharmacokinetics and toxicity of bismuth compounds. Med Toxicol Adverse Drug Exp 4:303–323
Playford RJ, Matthews CH, Campbell MJ, Delves HT, Hla KK, Hodgson HJ, Calam J (1990) Bismuth induced encephalopathy caused by tri potassium dicitrato bismuthate in patient with chronic renal failure. Gut 31:359–360
Mendelowitz PC, Hoffman RS, Weber S (1990) Bismuth absorption and myoclonic encephalopathy during bismuth subsalicylate therapy. Ann Intern Med 112:140–141
Jungreis AC, Schaumburg HH (1993) Encephalopathy from abuse of bismuth subsalicylate. Neurology 43:1265
Noach LA, Eechof JL, Bour LJ, Posthumus FE, Tytgat GN, Ongerboer de Visser BW (1995) Bismuth salts and neurotoxicity. A randomized, single-blind and controlled study. Hum Exp Toxicol 14:349–355
Hudson M, Ashley N, Mowat G (1989) Reversible toxicity in poisoning with colloidal bismuth subcitrate. BMJ 299:159
Hruz P (2002) Fanconi’s syndrome, acute renal failure and tonsil ulcerations after colloidal bismuth subcitrate intoxication. Am J Kidney Dis 39:E18
Islek I, Uysal S, Gok F, Dundaroz R, Kucukoduk S (2001) Reversible nephrotoxicity after overdose of colloidal bismuth subcitrate. Pediatr Nephrol 16:510–514
Akpolat I (1996) Acute renal failure due to overdose of colloidal bismuth. Nephrol Dial Transplant 11:1890–1891
Huwez F (1992) Acute renal failure after overdose of colloidal bismuth subcitrate. Lancet 340:1298
Taylor EG (1990) Acute renal failure after colloidal bismuth overdose. Lancet 335:670–671
Stevens PE, Moore DF, House IM, Volans GN, Rainford DJ (1995) Significant elimination of bismuth by hemodialysis with a new heavy-metal chelating agent. Nephrol Dial Transplant 10:696–698
Leussink BT, Slikkerveer A, Engelbrecht MR, Van der Voet GB, Nouwen EJ, de Heer E, de Broe ME, de Wolff FA, Bruijn JA (2001) Bismuth overdosing-induced reversible nephropathy in rats. Arch Toxicol 74:745–754
Leussink BT, Slikkerveer A, Krauwinkel WJ, van der Voet GB, de Heer E, de Wolff FA, Bruijn JA (2000) Bismuth biokinetics and kidney histopathology after bismuth overdose in rats. Arch Toxicol 74:349–355
Leussink BT, Nagelkerke JF, van de Water B, Slikkerveer A, van der Voet GB, Srinivasan A, Bruijn JA, de Wolff FA, de Heer E (2002) Pathways of proximal tubular cell death in bismuth nephrotoxicity. Toxicol Appl Pharmacol 15 180:100–109
Leussink BT, Litvinov SV, de Heer E, Slikkerveer A, van der Voet GB, Bruijn JA, de Wolff FA (2001) Loss of homotypic epithelial cell adhesion by selective N-cadherin displacement in bismuth nephrotoxicity. Toxicol Appl Pharmacol 175:54–59
Molina JA, Calandre L, Bermejo F (1989) Myoclonic encephalopathy due to bismuth salts: treatment with dimercaprol and analysis of CSF transmitters. Acta Neurol Scand 79:200–203
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cengiz, N., Uslu, Y., Gök, F. et al. Acute renal failure after overdose of colloidal bismuth subcitrate. Pediatr Nephrol 20, 1355–1358 (2005). https://doi.org/10.1007/s00467-005-1993-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-005-1993-7