Excretion, Distribution and Fate of Bismuth Under Clinical Conditions.

Abstract

The object of this study is to determine the limitations and usefulness, and, if possible, to establish better control, of bismuth therapy in syphilis by quantitative studies of the excretion of bismuth in urine and feces, its distribution in body fluids and organs, influence of various conditions on mobilization of stored bismuth, relationship of bismuth concentration and dosage to therapeutic efficiency, toxicity, etc., in human subjects, both convalescent and syphilitic. The plan includes also a study of various agents and conditions in experimental syphilis. Although the program of work is not yet completed, we desire to record certain results that have been obtained to date with 3 preparations, namely, metallic bismuth in suspension, potassium bismuth tartrate and bismuth salicylate used in single and multiple therapeutic doses by intramuscular injection. Briefly summarized, the main results are as follows: With all preparations, urinary excretion, using Leonard's method slightly modified and adapted to our material, is prompt, occurring on the second day after administration; the peak of excretion is reached at the end of about 12 days and then the excretion falls steadily but continues over long periods (weeks or months). The rapidity and quantity of bismuth excretion in urine appeared to be greatest with the tartrate (55% end of 53 days after 0.11 gm. Bi), probably less with the salicylate (uncompleted results) and least with the metal (24% end of 32 days after 1.2 gm. Bi.), while the order for duration is reversed. Increasing doses increase the excretion.