Bismuth - Toxicology of Metals - page 430

compounds (Dobes and Alden, 1949; Goldman and
Clarke, 1939). Ulcerative stomatitis has been observed
after bismuth therapy (Peters, 1942; Silverman, 1944).
Bismuth pigmentation has been found in the colon,
vagina, and the skin (Heyman, 1944).

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7.2.2.5 Other Effects
Colitis, gastrointestinal bleeding, purpura, agranu-
locytosis, and aplastic anemia have also been reported
resulting from administration of bismuth compounds
(Arena, 1974). Emile et al . (1981) reported osteoarticu-
lar lesions in 8 of 59 patients with bismuth encepha-
lopathy. The most common lesion was osteonecrosis of
the humeral head.

7.3 Carcinogenicity, Teratogenicity,
and Mutagenicity
There is no evidence of carcinogenicity or muta-
genicity of bismuth compounds, although bismuth
penetrates the placenta (Leonard and Love, 1928). No
teratogenicity has been reported.

8 T REATMENT OF BISMUTH POISON ING

According to Arena (1974), dimercaprol (BAL) yields
good results if given early. Other methods include the
administration of atropine and meperidine to relieve
gastrointestinal discomfort. Caution is required in
fl uid administration during anuric and oliguric phases
of nephrosis, but loss of fl uid and electrolytes should
be covered in the subsequent diuric phase (Karelitz
and Freedman, 1951). Basinger et al . (1983) reported
comparative studies on nine chelating agents with
respect to reducing bismuth toxicity. Compounds with
vicinal thiol groups were most effective, particularly if
adjacent aromatic hydroxyl groups were also present.
D-Penicillamine was the most effective compound
approved for clinical use.

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