Bismuth is poorly absorbed from the gastrointestinal tract and rapidly excreted in the urine, so toxicity following oral intake is uncommon.
Risk factors for bismuth intoxication:
(1) chronic, excessive oral intake
(2) renal dysfunction
(3) injection
Clinical findings in bismuth intoxication
(1) hypersalivation
(2) bluish line on the gums (from bismuth sulfate)
(3) stomatitis
(4) renal dysfunction
(5) variable hepatic injury
(6) variable peripheral neuritis
(7) variable skin rash
(8) osteopenia or osteoporosis (with chronic use, resulting in pathologic fractures)
(9) encephalopathy (with severe intoxication, see previous section)
Laboratory findings:
(1) elevated serum levels of bismuth (reported in µg/L)
Elimination of bismuth is enhanced following adminstration of BAL, DMSA and DMPS.
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Specialty: Toxicology, Emergency Medicine, Critical Care
