Severe iatrogenic bismuth poisoning with bismuth iodoform paraffin paste treated with DMPS chelation
| Autor: | Ivan House, Shona Murray, Alison L Jones, Hanna Ovaska, David M. Wood, Paul I. Dargan |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Antidotes chemistry.chemical_element Urine Toxicology Dosage form Bismuth chemistry.chemical_compound Postoperative Complications medicine Humans Chelation Chelation therapy Hydrocarbons Iodinated Aged Chelating Agents Pelvic Neoplasms Wound Healing Surgical wound Unithiol General Medicine Iodoform Surgery Drug Combinations chemistry Toxicity |
| Zdroj: | Clinical toxicology (Philadelphia, Pa.). 46(9) |
| ISSN: | 1556-9519 |
| Popis: | Bismuth iodoform paraffin paste (BIPP) is used for the packing of wound and surgical cavities. Features of both bismuth and iodoform toxicities have been associated with the use of BIPP, but there are no previous reports of 2,3-dimercaptopropane-1-sulphonate (DMPS) chelation therapy for bismuth poisoning secondary to its use.A 67-year-old man presented with a pelvic tumor requiring extensive surgical resection. BIPP packing was required post-operatively for surgical wound breakdown. A few days after insertion, the patient developed neurological features of bismuth toxicity (blood and urine bismuth concentrations were 340 microg/L and 2800 microg/L, respectively), which was treated with removal of the BIPP packing and DMPS chelation [27 days of intravenous DMPS (5 mg/kg 4 times daily for 5 days, 5 mg/kg three times daily for 5 days followed by 5 mg/kg twice a day for 17 days) followed by 24 days of oral DMPS (200 mg three times a day for 10 days, followed 200 mg twice daily for 14 days)]. This resulted in improvement in his symptoms and a decline in his pre-chelation bismuth concentration of 480 microg/L to 5 microg/L following chelation. There were no adverse effects during chelation.DMPS chelation appears to be a potentially effective chelating agent in bismuth toxicity. |
| Databáze: | OpenAIRE |
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