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HelpTest Code BIWB Bismuth, Blood
Reporting Name
Bismuth, BUseful For
Determining bismuth toxicity
Method Name
Inductively Coupled Plasma Mass Spectrometry (ICP-MS)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Whole bloodSpecimen Required
Patient Preparation: High concentrations of gadolinium and iodine are known to potentially interfere with most inductively coupled plasma mass spectrometry-based metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Supplies: Metal Free B-D Tube (EDTA), 6 mL (T183)
Collection Container/Tube: Royal blue top (EDTA) plastic trace element blood collection tube
Specimen Volume: 0.8 mL
Collection Instructions:
1. See Metals Analysis Specimen Collection and Transport for complete instructions.
2. Send whole blood specimen in original tube. Do not aliquot.
Specimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Whole blood | Refrigerated (preferred) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Reject Due To
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
Special Instructions
Reference Values
<1 ng/mL (unexposed)
4-30 ng/mL (therapeutic)
Day(s) Performed
Wednesday
CPT Code Information
83018
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BIWB | Bismuth, B | 8161-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 64274 | Bismuth, B | 8161-2 |
Clinical Information
Bismuth is used in the production of alloys, pigments, and chemical additives. Various compounds have also been used as therapeutic agents, astringents, and antacids.(1) Bismuth subsalicylate (Pepto-Bismol) is one example commonly used for indigestion and diarrhea.
In unexposed individuals, bismuth blood concentrations are typically less than 0.02 mcg/L compared to peptic ulcer patients taking bismuth medications where the concentrations ranged from 4 to 30 mcg/L.(2-4) Elimination from the body takes place primarily by the urinary and fecal routes, but the exact proportion contributed by each route is still unknown. Elimination from blood displays multicompartment pharmacokinetics with half-lives of 8 to 16 hours (early) and 5 to 11 days (late).(1)
A number of toxic effects have been attributed to bismuth compounds in humans including nephropathy, encephalopathy, osteoarthropathy, gingivitis, stomatitis, and colitis. Common early symptoms include salivation, mucosal swelling, discoloration of the tongue, gums, abdominal pain, and nausea.(1,6)
Interpretation
Normal blood concentrations for unexposed individuals are less than 1 ng/mL and the therapeutic range is 4 to 30 ng/mL.(2-5)
Cautions
No significant cautionary statements
Clinical Reference
1. Baselt R. Disposition of Toxic Drugs and Chemicals In Man. 10th ed. Biomedical Publications; 2014
2. Heitland P, Koster HD. Biomonitoring of 37 trace elements in blood samples from inhabitants of northern Germany by ICP-MS. J Trace Elem Med Biol. 2006;20(4):253-262
3. Serfontein WJ, Mekel R, Bank S, Barbezat G, Novis B. Bismuth toxicity in man-I. Bismuth blood and urine levels in patients after administration of a bismuth protein complex (Bicitropeptide). Res Commun Chem Pathol Pharmacol. 1979;26(2):383-389
4. Serfontein WJ, Mekel R. Bismuth toxicity in man II. Review of bismuth blood and urine levels in patients after administration of therapeutic bismuth formulations in relation to the problem of bismuth toxicity in man. Res Commun Chem Pathol Pharmacol. 1979;26(2):391-411
5. Sodi R. Vitamins and trace elements. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:417-417
6. Keogan DM, Griffith DM. Current and potential applications of bismuth-based drugs. Molecules. 2014;19(9):15258-97. doi:10.3390/molecules190915258
Method Description
The metal of interest is analyzed by inductively coupled plasma mass spectrometry.(Unpublished Mayo method)