Bismuth induced encephalopathy caused by tri potassium dicitrato bismuthate in a patient with chronic renal failure.
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.
Playford
R J
RJ
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Matthews
C H
CH
Campbell
M J
MJ
Delves
H T
HT
Hla
K K
KK
Hodgson
H J
HJ
Calam
J
J
D000368:Aged; D000863:Antacids / Q000009:adverse effects*; D001729:Bismuth / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D009942:Organometallic Compounds / Q000009:adverse effects*
D000863:Antacids; D009942:Organometallic Compounds; C002791:bismuth tripotassium dicitrate; D001729:Bismuth