From Big Medical Encyclopedia

BISMUTH (Bismuthum, Bi) — chemical element of the fifth group of a periodic system of elements of D. I. Mendeleyev; at. number 83, at. weight 208, 98. Some connections B. are applied how to lay down. drugs. Steady and several radioisotopes has one. Content in crust 2,0×10 - 5 weight. %. The main minerals B. are bismuthic gloss (Bi 2 S 3 ) and bismuth ochre (Bi 2 O 3 ). Besides, V. meets in a native state, and also in the form of impurity in ores of various metals (it is very frequent in ores of lead). Metal V. is received calcinating of its sulfur compounds to oxides and recovery then coal:

2Bi 2 S 3 + 9O 2 = 2Bi 2 O 3 + 6SO 2  ;

Bi 2 O 3 + 3C = 2 Bi + 3 CO.

Pure Century.— silvery and reddish solid brilliant metal, density 9,8, t ° pl 271 ° and t ° kip 1560 °; slightly is oxidized from a surface. Crystallizes in the form of rhombohedrons century. Metal V. is dissolved in mineral acids; at action konts. a chamois to - you are formed by Bi (SO 4 ) 3 , the diluted nitric — Bi (NO 3 ) 3 . With nek-ry metals B. forms bismuthides, e.g. Mg 3 Bi 2 . At an incandescence on air B. burns down with formation of an oxide of Bi 2 O 3 — solid matter of yellowish color, almost water-insoluble. The Bi (OH) bismuth hydroxide corresponding to oxide 3 shows weak amphoteric properties. It represents the white, almost insoluble flocculent residue which is easily passing with eliminating of water into an oxide. All salts B. are hydrolyzed with formation of basic salts. At action of strong oxidizers (Cl 2 ) in strongly alkaline condition pentavalent V.'s salts turn out (KBiO 3 or NaBiO 3 ), being strong oxidizers. At V.'s interaction with sulfur or at effect of hydrogen sulfide on salt B. Bi sulfide is formed 2 S 3 — black crystal substance. Halides B. of the Big3 type are easily formed at effect of free haloids for metal Century.

Metal Century. it is applied in metallurgy to receiving fusible alloys; many salts B. find application in medicine, perfumery, cosmetics, the photographic equipment. Professional poisonings or skin diseases during the work with V., as a rule, are not noted.

Drugs of bismuth

concern To them Dermatolum (see), xeroform (see), bismuth nitrate the main, biyokhinol (see), Bismoverolum (see) and Pentabismolum (see). Dermatolum, a xeroform and bismuth nitrate the main are applied as the knitting and antiseptic agents to treatment of diseases of skin and went. - kish. path. These drugs in the form of 5 — 10% of ointments and powders apply in dermatological practice. At eczemas they have the drying effect. Bismuth nitrate the main is used also at a peptic ulcer, enterita and colitis (on 0,25 — 0,5 g 2 — 3 times a day); it is a part of finished pharmaceutical products — Vicalinum, Vicairum and bisal. At use inside the bismuth sulfide which is formed in intestines is adsorbed on walls of guts and reduces a peristaltics.

Biyokhinol, Bismoverolum and Pentabismolum apply to treatment of syphilis and nonspecific inflammatory processes. At parenteral use drugs B. have antiinflammatory effect, a cut is shown in a rassasyvaniye of syphilides, nonspecific and aseptic inflammatory processes in c. N of page.

At treatment of syphilis, in addition to chemotherapeutic action, also normalization of immunological reactions often takes place.

The place of deposition of V. are kidneys, a liver, a spleen and bones (adjournment in a bone tissue can be revealed radiographic). Drugs B. generally with urine are removed, and also through went. - kish. path and sweat glands. Process of removal of bismuthic drugs is very long. So, during treatment and within a month after its termination only about a half of total quantity of the administered drug is removed. At repeated courses of treatment the speed of removal of drugs B. goes down even more.

Unlike a biyokhinol and Bismoverolum Pentabismolum is water-soluble drug of bismuth. At purpose of a course of treatment metal V.'s maintenance in 1 ml of drug (tab.) is considered.

Antisyphilitic drugs B. are used intramusculary. Injections do in an outside upper quadrant of a buttock. It is necessary to avoid hit in blood vessels since bismuthic drugs cause a blood coagulation. For treatment of syphilis bismuthic drugs combine with others. The best results are yielded by their combination to drugs of penicillinic group. At the same time co-administration with mercury and arsenous drugs is not recommended.

Complex therapy by drugs B. in combination with penicillin in a crust, time is widely applied; at the same time terms of treatment are reduced, indicators of the immediate and long-term results improve.

At treatment drugs B. often observe by-effects, the bismuthic border which is formed at the edges of gums and especially at carious teeth most often takes place. The bismuthic border (adjournment in a mucous membrane of bismuth sulfide) indicates saturation of an organism of V. and is not a contraindication to further treatment. However at development of ulites and stomatitises treatment by drugs B. needs to be interrupted.

Complications are observed and from urinary tract. The initial stage is determined by emergence in urine of epithelial cells with dark crystals (so-called bismuthic cells). The initial stage of irritation of urinary tract does not serve as the indication for interruption of treatment. The serious complication demanding the termination of treatment are emergence in urine of protein and a cylindruria.

Other complications, such as «bismuthic flu», toksikodermiya, arthralgias, meet seldom and their emergence serves as a contraindication for continuation of treatment as drugs B. Repeated use of drugs B. causes a recurrence of these complications.

The by-effects caused by disturbances of the technology of administration of drug are observed seldom. Hit of an oil suspension in a blood vessel is dangerous that can lead to an embolism of lungs. At a local embolism of a vessel there can be sharp pain in an injection site of drug giving to a leg also development of a local necrosis of fabrics is possible.

Contraindications to use of drugs B. are diseases of an oral cavity, kidneys, diabetes, hemorrhagic diathesis, medicinal intolerance of drugs B. If the medicinal intolerance of a biyokhinol is caused by quinine, then it is possible to use other drug B.

Use of drugs B. at pregnancy is categorically contraindicated.

Treatment of by-effects and complications depends on their weight. In mild cases (a bismuthic border) it is enough to be limited to careful care of an oral cavity.

In hard cases and at accidental poisonings medical actions shall be directed to strengthening of removal of V. from an organism and its inactivation. For this purpose apply diuretics, and also 5% solution of Unithiolum intramusculary (on 1 ml on 10 kg of weight of the patient).

Drugs B. are used also for treatment of children. In these cases of a dose establish depending on age of the child.

Bismuth in the medicolegal relation

Bismuth in the medicolegal relation matters at poisoning of hl. obr. the soluble compounds applied in medicine, cosmetics, perfumery etc. Almost insoluble connections B. can also be the reason of poisoning. At poisoning with connections B. the clinical phenomena and pathoanatomical changes have no specific character. As the proof of poisoning of V. serves the chemical and toxicological analysis of internals of a corpse (kidneys, a liver), urine, the fecal masses and other objects.

Isolation of connections B. from objects of a research is carried out by a mineralization by mix of sulfuric and nitric acids.

High-quality detection of V. in a mineralizata is based on reaction of education (in the presence of potassium iodide) the complex B. with 8 oxyquinoline painted in orange color. The complex is taken by mix of acetone and amyl acetate, the layer of organic solvent is painted at the same time in colors from light orange to bright crimson. Other reaction of high-quality detection of V. is reaction with thiourea. Sensitivity of each reaction of 0,005 mkg that allows to find apprx. 0,1 mg of V. on 100 g of fabrics of the studied body. As confirmatory reactions microcrystallic reactions for Century are used.

Quantitative definition of V. is carried out by means of volume (kompleksonometricheskiya) and photoelectrocolorimetric (on the basis of V.'s reaction with thiourea) methods.

The highest single and course doses of some drugs of bismuth for adults

Bibliography: Harmful substances in the industry, under the editorship of N. V. Lazarev, t. 2, page 478, L., 1971; To r y l about in and A. N. Definition of bismuth in biological material by method of compleximetric titration, Saturday. works on court. medical and court. chemistry, page 226, Perm, 1961; it, Definition of «metal» poisons by a fractional method, Court. - medical examination, No. 2, page 33, 1970; Mashkovsky M. D. Pharmaceuticals, p.1, page 267, M., 1972; Nekrasov B. V. Fundamentals of the general chemistry, t. 1 — 2, M., 1973; The Guide to pharmacology, under the editorship of N. V. Lazarev, t. 2, page 314, L., 1961; Shvaykova M. D. Toxicological chemistry, page 307, M., 1975.

R. K. Motorkina; N. Ya. Novitskaya (pharm.), M. D. Shvaykova (court.).