Severe iatrogenic bismuth poisoning with bismuth iodoform paraffin paste treated with DMPS chelation
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. Case Report. A 67-year-old man presented with a pelvic tumorrequiring extensive surgical resection. BIPP packing was required post-operatively for surgical wound breakdown. A few days after insertion, thepatient developed neurological features of bismuth toxicity (blood and urine bismuth concentrations were 340 μg/L and 2800 μg/L, respectively), which was treated with removal of the BIPP packing and DMPS chelation [27 days of intravenous DMPS (5 mg/kg 4 timesdaily 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 mgthree times a day for 10 days, followed 200 mg twice daily for 14 days)]. This resulted in improvement in his symptoms and a declinein his pre-chelation bismuth concentration of 480 μg/L to 5 μg/L following chelation. There were no adverse effects duringchelation. Conclusions. DMPS chelation appears to be a potentially effective chelating agent in bismuth toxicity.