Bismuth is generally not considered a health or environmental threat, at
least not anywhere near the level of Pb. One issue is that since Pb and Bi
are commonly associated in ores, the mining of Bismuth often involves
processing of Pb-containing materials. The only possible health issue I
have seen regarding Bi is a possible linkage to Alzheimer's-like dementia
associated with too much ingestion of Pepto-Bismol. This was quickly
reversible by elimination of Pepto-Bismol abuse..... (see insert
below)....it just goes to show that too much of almost anything is no
good....
The following is an excerpt from a Cominco (one of largest Bi producers)
Bismuth MSDS document, indicating that apparently the EU does not seen Bi as
a "dangerous substance::
SECTION 3. HAZARDS IDENTIFICATION
Emergency Overview: A silvery-white, lustrous metal that does not burn
except when dispersed into the air as a fine powder. The
metal is relatively non-toxic and poses little immediate hazard to personnel
or the environment in an emergency situation.
Potential Health Effects: May cause mild local irritation to the eyes, nose,
throat and upper airways. Bismuth is poorly absorbed
and is relatively non-toxic by inhalation or ingestion. It is not considered
a human carcinogen by OSHA, NTP, ACGIH, IARC, or the
EU. (see Toxicological Information, Section 11)
Potential Environmental Effects: Bismuth is not known to be a significant
threat to the environment. (see Ecological Information,
Section 12)
EU Risk Phrase(s): Not applicable - bismuth is not listed as a dangerous
substance.
PEPTO-BISMOL abuse....This is from
http://www.alzheimerscorp.com/article5.htm
Bismuth Toxicity Masquerading as Alzheimer's Dementia
By William K. Summers, MD
CASE REPORT
Journal of Alzheimer's disease - 1998
ABSTRACT: A 76-year old white married female had rapid onset dementia with
myoclonus and was admitted to an HMO hospital where she was initially
diagnosed with Alzheimer's disease. The physician-husband suggested that the
condition might be due to the Pepto-Bismol which she had taken chronically
to control her irritable bowel syndrome. An elevated serum bismuth level of
242 ug/L (normal is 5 ug/L) established bismuth toxicity as the cause of the
dementia. With treatment, the patient returned to a normal mental state. The
possibility of bismuth encephalopathy needs to be considered in the
differential diagnosis of possible Alzheimer's dementia.
INTRODUCTION: Bismuth was used in medicinal salves as early as 1733, and
internally for treatment of spasmodic bowels by the 1790s. Bismuth
preparations are generally considered very safe and are often taken without
knowledge of possible, albeit rare, neurotoxicity. Bierer's review of
bismuth subsalicylate (Pepto-Bismol) states that there have been no cases of
neurotoxicity in the United States (1). However, Gordon et al. reported a
case of a 54-year old man with suspected bismuth encephalopathy, who had
taken between 4 - 16 oz of Pepto-Bismol per day (1.04-4.16 mg/day of
bismuth) intermittently over many years to control gastrointestinal upset
and diarrhea (2). Unfortunately, the diagnosis was not suspected until the
35th day after the onset of his confusion, and the serum bismuth level was
only 3.6 ug/L in the serum. Typically, bismuth encephalopathy does not occur
without serum levels above 150 ug/L (7). We report below the case of bismuth
encephalopathy with a serum bismuth level of 242 ug/L, which was initially
incorrectly diagnosed as Alzheimer's disease.
CASE REPORT On February 29, 1996, a 76-year old Caucasian female was
admitted to a local HMO hospital with a one-week history of progressive
confusion, poor appetite, disturbed sleep and muscle twitching. Her
physician-husband noted that she became lost in their retirement complex
when attempting to do the laundry and that she complained of feeling like
"coming out of a binge". She would take up to an hour to figure out how to
put on her pajamas. Pertinent negatives included no history of fever, stiff
neck, headache, emesis, and diarrhea or alcohol abuse. The past medical
history was of migraine headaches, gastritis secondary to aspirin, Sjogren's
disease, multiple food allergies with malabsorption of wheat, corn, milk and
citrus products, and hypothyroidism. Trials on pancreases in the past did
not help the malabsorption. Her medications on admission were Inderal 10 mg
bid for migraine, Armor thyroid 2 gr. QAM, Premarin 0.625 mg qAM, Geritol
multiple vitamin qAM, stress tablet biw, benign class; that is, inorganic
salts which are insoluble in water (3).
An "epidemic outbreak" of over 1,000 cases of bismuth encephalopathy was
reported between 1973-1980 in France and Australia (2). Seventy-two of these
intoxications were fatal. Most occurred with chronic high-dose use of
bismuth subnitrate or bismuth subgallate (3). Since 1980, case reports of
bismuth encephalopathy have been infrequent. Nevertheless, there is higher
risk of such cases because of the ready availability of bismuth salts and
the increased use of Bismuth preparations in the treatment of Heliobacter
pylori related gastric and duodenal ulcers (4).
In consideration of this specific patient, the diagnosis should have been
suspected from the outset. Alzheimer's disease is an unrelenting progressive
neurodegenerative disorder of insidious onset that leads to death, on
average, 8 years after onset. Myoclonus is a very late and infrequent
feature of Alzheimer's disease. Bismuth toxicity typically presents
subacutely with mental changes of memory loss, psychosis and depression,
with a prominent background of ataxia, tremors, myoclonus and seizures (4).
In the present case, the onset was about a week, myoclonus was a prominent
feature, and although unstated in the initial HMO evaluation, it was obvious
that the patient had ataxia. The present case is a testimony for the need of
differential diagnosis evaluation of the demented patient. All too often,
the diagnosis of Alzheimer's disease is casually assigned. This practice
must be discouraged. This case also points out the role of active treatment
of the dementia aspects of patients. She was able to return to a normal
life, possibly months before anticipated, because of the use of Tacrine.
Finally, this case exemplifies the reason that it is logical to test bismuth
in the "heavy metal screen."
References:
Bierer DW, Bismuth Subsalicylate: History, Chemistry, and Safety, Reviews of
Infectious Disease 12 supp (1990) S3-S8.
Gordon MF, Abrams RI, Rubin DB, Barr WB, Correa DD, Bismuth Subsalicylate
toxicity as a case of prolonged encephalopathy with myoclonus, Movement
Disorders 10 (2) (1995) 220-222.
Serfontein WJ, Mekel R, Bismuth toxicity in man II. Research Communications
in Chemical Pathology and Pharmacology, 26 (2) (1979) 391-411.
Shreeve DR, A double-blind study of tripotassium di-citrano bismuthate in
duodenal ulcer, Postgraduate Medicine Journal 51 (Suppl 5) (1975) 33-36.
Slikkerveer A De Wolff FA, Pharmacokinetics a toxicity of bismuth compounds,
Medical Toxicity and Adverse Drug Experience 4 (5) (1989) 303-323.
Summers WK, DeBoynton VL, Marsh GM, Majovski LJ, Comparison of seven
psychometric instruments used for evaluation of treatment effect in
Alzheimer's disease, Neuroepidemiology 9 (1990) 193-207.
Supino-Viterbo V, Sicard C, Risvegliato M, Rancurel G, Buge A, Toxic
encephalopathy due to ingestion of bismuth salts: clinical and EEG studies
of 45 patients, Journal of Neurology, Neurosurgery, and Psychiatry 40 (1977)
748-752
The NM Senior Citizen News publishes these articles monthly. You can pick up
a copy of the paper at your closest New Mexico Senior Citizen Center.
Regards,
Leo
------------------------------------
Leo M. Higgins III, Ph.D.
Central Region Mgr. / Director of Sales
[log in to unmask]
3755 Capital of Texas Hwy-So
Suite 100
Austin, TX USA 78726
tel: 512-383-4593
fax: 512-383-1590
mobile: 512-423-2002
------------------------------------
-----Original Message-----
From: Barr, Bob [mailto:[log in to unmask]]
Sent: Thursday, January 22, 2004 12:07 PM
To: [log in to unmask]
Subject: Re: [TN] Lead-free Component Finishes
Re: Bi,
I am a little surprised to see Bi as a leading candidate. At a seminar I
attended, the subject of Bi in solder was discussed. I thought I heard that
Bi was meeting resistance, especially in Europe, because the environmental
issues with it were worse than the lead it was replacing. Not being a
chemist, I don't know which is worse from a landfill toxicity viewpoint -
2%Bi or 37%Pb. It is also quite possible I misunderstood what was said about
Bi! Is Bi as a component of solder an environmental concern?
Thanks.
=========================
Bob Barr
Manufacturing Engineering
Formation, Inc.
=========================
> -----Original Message-----
> From: Leo Higgins [mailto:[log in to unmask]]
> Sent: Thursday, January 22, 2004 12:07 PM
> To: [log in to unmask]
> Subject: Re: [TN] Lead-free Component Finishes
>
>
> In Japan most companies are moving towards Sn-Bi lead
> finishes (typically
> Sn-2Bi), ...message snipped...
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