Extradural application of bismuth iodoform paraffin paste causing relapsing bismuth encephalopathy: a case report with CT and MRI studies.

Sharma, Rewati Raman; Cast, I P; Redfern, Robert M.; O'Brien, C J

doi:10.1136/jnnp.57.8.990

Cited by 36 publications

(19 citation statements)

References 9 publications

(1 reference statement)

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“…For example, a case of relapsing neuropsychiatric symptoms in a woman following excision of a large cranial basal cell carcinoma with topical application of BIP paste in the extradural space has been reported. This patient redeveloped bismuth encephalopathy on reapplication of the pack following improvement after its removal 10 . A case of encephalopathy following intraoral use of BIP paste used during a dental procedure has also been reported.…”

Section: Discussionmentioning

confidence: 82%

Beware of Bismuth: Post maxillectomy delirium

Harris

Poole

2002

ANZ Journal of Surgery

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Section: Discussionmentioning

confidence: 82%

Beware of Bismuth: Post maxillectomy delirium

Harris

Poole

2002

ANZ Journal of Surgery

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“…As the blood iodoform level can not be measured directly 4) , iodoform toxicity is diagnosed based on the blood iodine level. The blood iodine level in iodoform toxicity has been reported to be between 31.6 -977 μg/dl (normal range: 4 -9 μg/dl), with one case being reported as having a level as high as 6,280 μg/dl 5) .…”

Section: Discussionmentioning

confidence: 99%

Intoxication caused by iodoform gauze packing in necrotizing fasciitis

Nakamura

Inokuchi

Fujita

et al. 2011

Nihon Shuchu Chiryo Igakukai zasshi

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While iodoform gauze has a good antiseptic effect, cases of iodoform toxicity are not common. Iodoform can cause neurological symptoms such as disturbance of consciousness, and intoxication occurs with relative ease under certain suitable conditions. Medical practitioners may often misdiagnose disturbance of consciousness for various reasons, and the actual cause of disturbance of consciousness should be clarified. We now report a case of prolonged disturbance of consciousness caused by the use of iodoform gauze in the treatment of necrotizing fasciitis. A 70-year-old diabetic female, who used insulin injections, acquired necrotizing fasciitis in her left buttock and underwent surgery involving release of purulent discharge and debridement. The surgical area was packed with iodoform gauze following surgery, and the gauze was replaced daily. The patient's general condition gradually improved, but disturbance of consciousness, around Glasgow coma scale E2VTM4, was prolonged. We discontinued iodoform gauze treatment, following which consciousness improved slowly. The blood serum iodine level was too high. Although we often use iodoform gauze as an effective treatment for infected sites, we must take heed of its potential toxic neurological effects.

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“…The most severe adverse effect of bismuth reported is bismuth-induced encephalopathy (Martin-Bouyer et al 1981;Sharma et al 1994). Bismuth encephalopathy was described in France in the 1970's during an epidemic incidence involving more than 900 patients, 72 of whom died from their condition.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal and Systemic Uptake of Bismuth in Mice after Oral Exposure

Martiny¹,

Stoltenberg²,

Danscher³

et al. 2003

Pharmacol Toxicol

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Bismuth compounds have been used in medicine for more than 200 years. In recent years, bismuth has gained renewed interest as a remedy for eradication of gastrointestinal pathogens, especially Helicobacter pylori. In this study we describe the anatomical distribution of bismuth in the gastrointestinal tract and other organs after oral exposure in a mouse model. After exposure of the experimental animals to ranitidine bismuth citrate or bismuth citrate, we used the autometallographic silver enhancement technique to demonstrate the presence of bismuth in tissue samples from the gastrointestinal tract, liver, spleen, thymus, kidney and lymph nodes. We exposed cultured murine peritoneal macrophages to bismuth citrate and examined the bismuth accumulation over time. We found that in the mouse bismuth is absorbed systemically after a single dose of either compound, ranitidine bismuth more easily than bismuth citrate. Uptake could be shown in the stomach, duodenum, ileum and kidney for hours after exposure. Weeks after the exposure, deposits of bismuth were found in lymph nodes, liver, spleen and kidney as well as in macrophages in the gastrointestinal lamina propria. At the subcellular level, bismuth was found exclusively in lysosomes, primarily in macrophages and dendritic cells. Subsequent analyses of macrophage cultures showed lysosomal accumulations to be time and dose dependent.

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Extradural application of bismuth iodoform paraffin paste causing relapsing bismuth encephalopathy: a case report with CT and MRI studies.

Cited by 36 publications

References 9 publications

Beware of Bismuth: Post maxillectomy delirium

Beware of Bismuth: Post maxillectomy delirium

Intoxication caused by iodoform gauze packing in necrotizing fasciitis

Gastrointestinal and Systemic Uptake of Bismuth in Mice after Oral Exposure

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