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Test Code MISC2MAYOBIWB Bismuth, Blood

Useful For

Determining bismuth toxicity

Method Name

Inductively Coupled Plasma Mass Spectrometry (ICP-MS)

Reporting Name

Bismuth, B

Specimen Type

Whole blood


Specimen 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

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)

Reference Values

<1 ng/mL (unexposed)

4-30 ng/mL (therapeutic)

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)

Method Description

The metal of interest is analyzed by inductively coupled plasma mass spectrometry.(Unpublished Mayo method)

Day(s) Performed

Wednesday

Report Available

1 to 8 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

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

Secondary ID

64274