Ovaska Hanna, Wood David M, House Ivan, Dargan Paul I, Jones Alison L, Murray Shona
Guy's and St Thomas' Poisons Unit, Medical Toxicology Unit, London, United Kingdom.
Clin Toxicol (Phila). 2008 Nov;46(9):855-7. doi: 10.1080/15563650801953182.
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.
铋碘仿石蜡糊剂（BIPP）用于伤口和手术腔隙的填充。铋和碘仿的毒性特征均与BIPP的使用有关，但此前尚无关于二巯丙磺酸钠（DMPS）螯合疗法治疗因使用BIPP导致铋中毒的报道。
一名67岁男性因盆腔肿瘤需要进行广泛手术切除。术后因手术伤口裂开需要使用BIPP填充。插入几天后，患者出现铋中毒的神经症状（血液和尿液中铋浓度分别为340微克/升和2800微克/升），通过移除BIPP填充并采用DMPS螯合疗法进行治疗[静脉注射DMPS 27天（5毫克/千克，每日4次，共5天；5毫克/千克，每日3次，共5天；随后5毫克/千克，每日2次，共17天），然后口服DMPS 24天（200毫克，每日3次，共10天；随后200毫克，每日2次，共14天）]。这使得他的症状得到改善，螯合治疗后铋浓度从螯合前的480微克/升降至5微克/升。螯合治疗期间未出现不良反应。
DMPS螯合疗法似乎是治疗铋中毒的一种潜在有效螯合剂。
