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ACUTE EXPOSURE INFORMATION

  1. USES: Bismuth is a metal that is formulated into a salt used in medications for the treatment of nausea, vomiting, and diarrhea, in surgical paste for ileostomies and colostomies, and as an adjunct in the treatment of ulcers.
  1. PHARMACOLOGY: The pharmacological mechanism of bismuth is not clear. It may have protective effects in the gastric mucosa and it inhibits the growth of H. pylori.
  1. TOXICOLOGY: Bismuth toxicity varies regarding both onset and type of toxicity due to the solubility of the salt form administered. Binds sulfhydryl groups, especially in the CNS, resulting in loss of white matter and specifically Purkinje cells and encephalopathy. Also causes degeneration of proximal tubules in the kidney, resulting in nephrotoxicity.
  1. EPIDEMIOLOGY: Ingestion of bismuth products is common, but toxicity from bismuth is rare and deaths have not been reported.
  1. WITH POISONING/EXPOSURE
    1. MILD TO MODERATE POISONING: Can cause oral mucosal lesions, nausea, vomiting, and diarrhea. Chronic use can cause discoloration of the skin, oral, or vaginal mucosa.
    1. SEVERE POISONING: Chronic intoxication can cause encephalopathy which can manifest as mental status changes, such as memory loss, confusion, delirium, psychosis, depression, insomnia, difficulty in concentration, ataxia, tremors, myoclonus, and seizures. Acute renal failure has been reported after large ingestions.
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