title: 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.
authors.affiliation: Department of Pediatric Nephrology, Faculty of Medicine, Adana Teaching and Medical Research Center, Baskent University, 01140 Adana, Turkey. nurcem@yahoo.com
authors.forename: Nurcan
authors.initials: N
authors.lastname: Cengiz
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Uslu
authors.forename: Faysal
authors.initials: F
authors.lastname: Gök
authors.forename: Ali
authors.initials: A
authors.lastname: Anarat
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy; D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000506:poisoning*; D002614:Chelating Agents / Q000627:therapeutic use; D062787:Drug Overdose / Q000150:complications; D005260:Female; D006801:Humans; D009942:Organometallic Compounds / Q000506:poisoning*; D010396:Penicillamine / Q000627:therapeutic use; D006435:Renal Dialysis; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D002614:Chelating Agents; D009942:Organometallic Compounds; D010396:Penicillamine; C002791:bismuth tripotassium dicitrate