Determining bismuth toxicity
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
Bi (Bismuth)
Whole blood
Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Collection Container/Tube:
Preferred: Royal blue top (EDTA) plastic trace element blood collection tube
Specimen Volume: 0.8 mL
Collection Instructions:
1. See Trace Metals Analysis Specimen Collection and Transport for complete instructions.
2. Send whole blood specimen in original tube. Do not aliquot.
0.25 mL
Gross hemolysis | OK |
Gross lipemia | OK |
Gross icterus | OK |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Whole blood | Refrigerated (preferred) | 28 days | |
Ambient | 28 days | ||
Frozen | 28 days |
Determining bismuth toxicity
Bismuth is used in the production of alloys, pigments, and chemical additives. Various compounds have also been used as therapeutic agents, astringents, antacids.(1) Bismuth subsalicylate (Pepto-Bismol) is one example commonly used for indigestion and diarrhea.
In unexposed individuals, bismuth blood concentrations were typically less than 0.02 mcg/L compared to peptic ulcer patients taking bismuth medications where the concentrations ranged from 4 to 30 mcg/L.(2-4) Elimination from the body takes place primarily by the urinary and fecal routes, but the exact proportion contributed by each route is still unknown. Elimination from blood displays multicompartment pharmacokinetics with half-lives of 8 to 16 hours (early) and 5 to 11 days (late).(1)
A number of toxic effects have been attributed to bismuth compounds in humans including: nephropathy, encephalopathy, osteoarthropathy, gingivitis, stomatitis, and colitis. Common early symptoms include salivation, mucosal swelling, discoloration of the tongue, gums, abdominal pain, and nausea.(1)
<1 ng/mL (unexposed)
4-30 ng/mL (therapeutic)
Normal blood concentrations for unexposed individuals are less than 1 ng/mL and the therapeutic range is 4 to 30 ng/mL.(2-4)
No significant cautionary statements
1. Baselt R: Disposition of Toxic Drugs and Chemicals In Man. 10th ed. Biomedical Publications; 2014
2. Heitland P, Koster HD: Biomonitoring of 37 trace elements in blood samples from inhabitants of northern Germany by ICP-MS. J Trace Elem Med Biol. 2006;20(4):253-262
4. Serfontein WJ, Mekel R: Bismuth toxicity in man II. Review of bismuth blood and urine levels in patients after administration of therapeutic bismuth formulations in relation to the problem of bismuth toxicity in man. Res Commun Chem Pathol Pharmacol. 1979 Nov;26(2):391-411
5. Roberts NB, Taylor A, Sodi R: Vitamins and trace elements. Rifai N, Horvath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:chap 37
The metal of interest is analyzed by inductively coupled plasma mass spectrometry.(Unpublished Mayo method)
Wednesday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
83018
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
BIWB | Bismuth, B | 8161-2 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
64274 | Bismuth, B | 8161-2 |