How to Treat Bismuth Poisoning

Bismuth is a stable element and cannot be broken down or otherwise destroyed. Bismuth poisoning occurs primarily from the ingestion of bismuth chelate, particularly by the increasing numbers of colostomy patients. Occupational bismuth poisoning remains rare. The following steps will help you identify and treat a case of bismuth poisoning.

Instructions

• 1

  Know the symptoms. Chronic ingestion of bismuth causes a distinctive dark line around the gums known as a "bismuth line" and can affect the kidneys and liver. Ingestion of insoluble bismuth salts can cause headaches, kidney damage and rashes.

• 2

  Consider gastric lavage only if a major ingestion of bismuth has occurred within one hour. Check for bismuth on an X-ray for several hours following ingestion because bismuth does not absorb X-rays. Minor ingestion of bismuth can be handled with basic supportive care.

• 3

  Perform a modified Reinsch's test as a fast, reliable presumptive test. Obtain 10 to 15 g of the gastric contents and add 3 ml of concentrated hydrochloric acid. Insert a spiral of copper wire and gradually heat it for two hours. A shiny black deposit can indicate the presence of bismuth.

• 4

  Replace fluids as needed and monitor renal and liver function for several days. Treat renal and liver failures conventionally. A diagnosis of bismuth poisoning can be confirmed by checking bismuth levels in the blood.

• 5

  Provide artificial ventilation and sedation for severe cases of bismuth poisoning. Chelation with dimercaprol, penicillamine other chelates should only be considered in life threatening cases.