Acute renal failure after overdose of colloidal bismuth subcitrate

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 microg/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.

Comparison of three different regimens against Helicobacter pylori as a first-line treatment: A randomized clinical trial

“…Many prospective studies were recently performed, and all of these regimens seem to be highly effective in the eradication of H. pylori [11,17,18,[21][22][23][24]. Although, QT is a highly effective regimen that could be recommended as a first-line therapy, bismuth is not available in many developed countries due to its potential nephrotoxicity [25][26][27]. However, the results of a meta-analysis that included 35 randomized controlled trials involving 4763 patients detected no statistically significant difference in the total number of adverse events after the use of bismuth.…”

A case of bismuth intoxication with irreversible renal damage

“…Bismuth binds to a metal binding protein in proximal renal tubule cells and remains bound in this way for months. 3 In acute bismuth nephrotoxicity, renal blood flow and glomerular filtration rate are both decreased. The damaged tubules in the corticomedullary boundary zone were identified as S 3 segments of the proximal tubule in a previous experiment, on the basis of their anatomical location, their characteristic large brush borders, and the absence of Tamm-Horsefall protein.…”

“…In a few case reports, acute renal failure was described. 3 The reported toxic effects caused by overdose of bismuth compounds include encephalopathy, nephropathy, osteoarthropathy, gingivostomatitis, and colitis. 3 Bismuth poisoning mostly affects the kidney, liver, and bladder.…”

“…3 The reported toxic effects caused by overdose of bismuth compounds include encephalopathy, nephropathy, osteoarthropathy, gingivostomatitis, and colitis. 3 Bismuth poisoning mostly affects the kidney, liver, and bladder. Chronic exposure to high levels of bismuth salts result in encephalopathy, whereas acute toxicity manifests as nephrotoxicity.…”

A Case Presentation of Colloidal Bismuth Subcitrate Intoxication and Acute Renal Failure

“…ve gingivostomatit şeklinde etkileri de gözlenebilmektedir [3] . KBS oral alındıktan sonra düşük seviyelerde (<%1) emilime uğrar [4] ve büyük kısmı gastrointestinal sistemden feces ile vücuttan atılır, çok az bir kısmı ise böbrekten atılır.…”