{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T10:24:44Z","timestamp":1781951084537,"version":"3.54.5"},"reference-count":10,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1990,3]]},"abstract":"<jats:p>A 68 year old man with a creatinine clearance rate of only 15 ml\/min took twice the recommended dose of tripotassium dicitrato bismuthate (TDB) as DeNol liquid; 10 ml qds; a total of 864 mg bismuth daily for two months. Whole blood bismuth concentrations rose to 880 micrograms\/l and he developed global cerebral dysfunction with hallucinations, ataxia, and an abnormal EEG. Renal clearance of bismuth rose from 0.24 to 2.4 ml\/min when the heavy metal chelator 2-3 dimercapto-1 propane sulphonic acid (DMPS) was given by mouth. Bismuth was measured by a novel method involving inductively coupled plasma source mass spectrometry. Fifty days after stopping TDB, whole blood bismuth concentrations fell to 46 micrograms\/l and the patient's EEG returned to normal. His mental function also recovered completely. The case serves as a timely reminder that TDB should not be administered to patients with renal disorders, as stated in the data sheet.<\/jats:p>","DOI":"10.1136\/gut.31.3.359","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"359-360","source":"Crossref","is-referenced-by-count":50,"title":["Bismuth induced encephalopathy caused by tri potassium dicitrato bismuthate in a patient with chronic renal failure."],"prefix":"10.1136","volume":"31","author":[{"given":"R J","family":"Playford","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C H","family":"Matthews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M J","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H T","family":"Delves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K K","family":"Hla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H J","family":"Hodgson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Calam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1990,3,1]]},"reference":[{"key":"ref_1","article-title":"May 1989 as stated in the data sheet","unstructured":"May 1989 as stated in the data sheet."},{"key":"ref_2","first-page":"1009","article-title":"Biomedical applications of ICP-MS","volume":"24","author":"Delves, H.T.","year":"1988","unstructured":"Delves HT. Biomedical applications of ICP-MS. Chem Br 1988; 24: 1009-12.","journal-title":"Chem Br"},{"key":"ref_3","first-page":"912","article-title":"Request for reports: Adverse reactions with bismuth subgallate","volume":"60","author":"Morrow, A.W.","year":"1973","unstructured":"Morrow AW. Request for reports: Adverse reactions with bismuth subgallate. Medj Austr 1973; 60: 912.","journal-title":"Medj Austr"},{"key":"ref_4","first-page":"307","article-title":"Aspects epidemiologiques des encephalopathies apres administration de bismuth par voie oral","volume":"35","author":"Martin-Bouyer, G.; Foulon, B.; Guerbois, H.; Barin, C.","year":"1980","unstructured":"Martin-Bouyer G, Foulon B, Guerbois H, Barin C. Aspects epidemiologiques des encephalopathies apres administration de bismuth par voie oral. 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Antibacterial action of bismuth in relation to Campylobacter pyloridis colonisation and gastritis. Digestion 1987; 37: 8-15.","journal-title":"Digestion"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1365-2036.1989.tb00187.x","article-title":"Bismuth accumulates in the body during treatment with tripotassium dicitrato bismuthate","volume":"3","author":"Cj, Gavey; NL, Szeto; CU, Nwokolo; J, Sercombe; RE, Pounder","year":"1989","unstructured":"Gavey Cj, Szeto NL, Nwokolo CU, Sercombe J, Pounder RE. Bismuth accumulates in the body during treatment with tripotassium dicitrato bismuthate. Aliment Pharmacol Ther 1989; 3:21-8.","journal-title":"Aliment Pharmacol Ther"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/j.1365-2036.1989.tb00188.x","article-title":"The absorption of bismuth from oral doses of tripotassium dicitrato bismuthate","volume":"3","author":"Nwokolo, C.U.; Gavey, C.J.; Smith, J.T.L.; Pounder, R.E.","year":"1989","unstructured":"Nwokolo CU, Gavey CJ, Smith JTL, Pounder RE. The absorption of bismuth from oral doses of tripotassium dicitrato bismuthate. Aliment Pharnacol Ther 1989; 3: 29-39.","journal-title":"Aliment Pharnacol Ther"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1136\/pgmj.64.750.308","article-title":"Neuropsychiatric symptoms following bismuth intoxication","volume":"64","author":"Weller, M.P.","year":"1988","unstructured":"Weller MP. Neuropsychiatric symptoms following bismuth intoxication. Postgrad MedJr 1988; 64: 308-10.","journal-title":"Postgrad MedJr"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1146\/annurev.pa.23.040183.001205","article-title":"DMSA and DMPS-Water soluble antidotes for heavy metal poisoning","volume":"23","author":"Vasken-Aposhian, H.","year":"1983","unstructured":"Vasken-Aposhian H. DMSA and DMPS-Water soluble antidotes for heavy metal poisoning. Ann Rev Pharmacol Toxicol 1983; 23: 193-215.","journal-title":"Ann Rev Pharmacol Toxicol"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.31.3.359","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:57:28Z","timestamp":1765605448000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.31.3.359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1990,3]]},"references-count":10,"journal-issue":{"issue":"3","published-online":{"date-parts":[[1990,3,1]]},"published-print":{"date-parts":[[1990,3]]}},"alternative-id":["10.1136\/gut.31.3.359"],"URL":"https:\/\/doi.org\/10.1136\/gut.31.3.359","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1990,3]]}}}