Reversible nephrotoxicity after overdose of colloidal bismuth subcitrate

Although toxicity due to acute and chronic use of bismuth salts is well kno wn, nephrotoxicity after ingestion of colloidal bismuth has been reported i n few cases so far. Here we report the first case of acute renal failure (A RF) due to colloidal bismuth subcitrate overdosage in childhood. A 2-year-o ld boy was admitted to the hospital 6 h after ingestion of 28 De-Nol tablet s (colloidal bismuth subcitrate 8.4 g). On admission, physical examination was unremarkable and he showed no signs of encephalopathy. Initially gastri c lavage was performed then appropriate fluid therapy was started. ARF asso ciated with uremia and oliguria developed on day 2 and peritoneal dialysis therapy was prescribed on day 4 for 10 days. Blood and urine bismuth levels were 739 mug/l and 693 mug/l, respectively, 10 days after the pills had be en taken. His urine volume gradually increased and plasma BUN and creatinin e levels decreased during peritoneal dialysis. On day 20 post-admission, pl asma BUN and creatinine were 14 mg/dl and 0.7 mg/dl, respectively. Blood bi smuth levels were 96 mug/l on day 60 and 12 mug/l on day 105. Now the patie nt is well and has no problem. This case suggests that ARF may develop in c hildren following colloidal bismuth subcitrate overdosage: the prognosis is good, and peritoneal dialysis may be useful in these cases.