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Bismuth

المؤلف:  Sue Jickells , Adam Negrusz (Editors)

المصدر:  Clarkes Analytical Forensic Toxicology

الجزء والصفحة:  105

2026-09-22

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Bismuth

Bismuth, a heavy metal, produces toxicity that can sometimes mimic that associated with lead and mercury. For this reason, it can be useful to include bismuth in any heavy-metal screening procedure undertaken in patients with unexplained neurological symptoms. Bismuth salts have been used in medicine for more than a century, such as in the treatment of gastrointestinal disorders, and are available in over-the counter preparations. Some inorganic salts of bismuth are relatively insoluble in water and cause minimal toxicity, whereas other compounds, particularly lipid-soluble organic compounds, are known to accumulate in the body after excessive dosing and can cause severe neurotoxicity. Water-soluble compounds of bismuth are more likely to cause renal damage, including acute renal failure. A number of deaths have been reported after acute and chronic overdose with various bismuth medicinal products. Measurement of urinary bismuth concentrations may be useful diagnostically or after treatment of poisoning using oral chelating agents, which can greatly increase urinary clearance of bismuth. Reference values for bismuth in blood and urine are low (<1 μg/L). Acceptable ‘therapeutic concentrations’ in blood are generally up to 50 lg/L. Concentrations >100 lg/L are generally associated with toxicity and concentrations >1000 lg/L may be found in patients with severe neurological symptoms such as encephalopathy.