Bismuth subnitrate and iodoform paste
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Various toxicities (first report of depression and suicidal ideation): case report A male [age not stated] developed various toxicities including depression and suicidal ideation after bismuth subnitrate and iodoform paste was used to pack a keratocystic odontogenic tumour (KOT). The patient, who had an extensive KOT, underwent marsupialisation and packing of the tumour and had several packs of bismuth subnitrate and iodoform paste placed sequentially [therapeutic indication and dosage not stated]. Following each procedure, he progressively became more fatigued and apathetic [time to reaction onset not stated]. Direct questioning revealed quadriceps muscle spasms and suspicions of bismuth toxicity were raised. While a bismuth assay was being processed, he became clinically depressed; he developed suicidal ideation and required psychiatric admission. His bismuth level was found to be 200 times the normal value. The patient was prescribed conventional antidepressant therapy and his mood improved [patient outcome not clearly stated]. The cyst cavity was obturated and he no longer required a bismuth subnitrate and iodoform paste pack. Author comment: "Circulating levels of bismuth may increase if [bismuth subnitrate and iodoform paste] is used, as cyst cavities have a large surface area for absorption." Atwal A, et al. Suicidal ideation secondary to bismuth toxicity following packing of a keratocystic odontogenic tumour. British Journal of Oral and Maxillofacial Surgery 50: S57, Jun 2012. Available from: URL: http://dx.doi.org/10.1016/ 803076600 j.bjoms.2012.04.119 [Abstract] - United Kingdom
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Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous case reports of depression or suicidal ideation associated with bismuth subnitrate and iodoform paste.
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Reactions 8 Sep 2012 No. 1418
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