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.
Subject(s)
Acute Kidney Injury/chemically induced , Anti-Ulcer Agents/poisoning , Organometallic Compounds/poisoning , Acute Kidney Injury/drug therapy , Acute Kidney Injury/therapy , Adolescent , Chelating Agents/therapeutic use , Drug Overdose/complications , Female , Humans , Penicillamine/therapeutic use , Renal Dialysis , Suicide, Attempted , Treatment OutcomeABSTRACT
Although toxicity due to acute and chronic use of bismuth salts is well known, nephrotoxicity after ingestion of colloidal bismuth has been reported in few cases so far. Here we report the first case of acute renal failure (ARF) due to colloidal bismuth subcitrate overdosage in childhood. A 2-year-old boy was admitted to the hospital 6 h after ingestion of 28 De-Nol tablets (colloidal bismuth subcitrate 8.4 g). On admission, physical examination was unremarkable and he showed no signs of encephalopathy. Initially gastric lavage was performed then appropriate fluid therapy was started. ARF associated with uremia and oliguria developed on day 2 and peritoneal dialysis therapy was prescribed on day 4 for 10 days. Blood and urine bismuth levels were 739 micrograms/l and 693 micrograms/l, respectively, 10 days after the pills had been taken. His urine volume gradually increased and plasma BUN and creatinine levels decreased during peritoneal dialysis. On day 20 post-admission, plasma BUN and creatinine were 14 mg/dl and 0.7 mg/dl, respectively. Blood bismuth levels were 96 micrograms/l on day 60 and 12 micrograms/l on day 105. Now the patient is well and has no problem. This case suggests that ARF may develop in children following colloidal bismuth subcitrate overdosage; the prognosis is good, and peritoneal dialysis may be useful in these cases.
Subject(s)
Acute Kidney Injury/chemically induced , Anti-Ulcer Agents/poisoning , Organometallic Compounds/poisoning , Acute Kidney Injury/blood , Acute Kidney Injury/therapy , Acute Kidney Injury/urine , Bismuth/blood , Blood Urea Nitrogen , Child, Preschool , Colloids , Creatinine/blood , Drug Overdose , Humans , Male , Peritoneal DialysisABSTRACT
Cisapride is an oral prokinetic agent used to facilitate or restore motility in the gastrointestinal tract. The National Animal Control Center has received 17 reports of accidental overexposure of dogs to cisapride since 1994. Doses of 640 mg/kg in dogs were reported to be lethal, but severe clinical signs have been noted at acute exposures as low as 18 mg/kg. The most common signs include diarrhea, muscle tremors and fasciculations, ataxia and incoordination, and hyperthermia. Available treatment is symptomatic and supportive. Activated charcoal is effective in reducing plasma cisapride levels.
Subject(s)
Anti-Ulcer Agents/poisoning , Dog Diseases/chemically induced , Gastrointestinal Motility/drug effects , Piperidines/poisoning , Administration, Oral , Animals , Anti-Ulcer Agents/pharmacokinetics , Anti-Ulcer Agents/pharmacology , Anti-Ulcer Agents/therapeutic use , Cisapride , Dog Diseases/therapy , Dogs , Drug Interactions , Drug Overdose/therapy , Drug Overdose/veterinary , Half-Life , Intestinal Absorption/drug effects , Male , Piperidines/pharmacokinetics , Piperidines/pharmacology , Piperidines/therapeutic use , Poison Control CentersABSTRACT
An elderly woman presented with pneumonia and mental status changes and was found to have bromide poisoning due to ingestion of propantheline bromide over a 2-month period. The interference of bromide with serum chloride measurements on an ion-selective electrode resulted in spurious hyperchloremia and was crucial in making the diagnosis. To our knowledge, bromide intoxication due to propantheline bromide has not been reported previously.
Subject(s)
Anti-Ulcer Agents/poisoning , Bromine/poisoning , Propantheline/poisoning , Aged , Aged, 80 and over , Female , Humans , Poisoning/diagnosisABSTRACT
Misoprostol (Cytotec) is a recently released prostaglandin E1 analog approved for use in prevention of nonsteroidal anti-inflammatory drug-induced gastropathy. We report one of the first known examples of toxicity in an acute ingestion since the drug was first released in international markets in 1984. After an accidental ingestion of 3 mg misoprostol (approximately 15 times the maximum recommended therapeutic dose), a 71-year-old woman exhibited fever, tremor, tachycardia, hypertension, nausea, and abdominal cramping. Recovery ensued with standard supportive care. The physiology of this unique drug and implications for management of acute toxicity are summarized.
