Abstract
Stieglitz 1 advocated the use of bismuth subnitrate in the treatment of hypertension. He suggested that the nitrate was partially reduced in the intestine and that the absorbed nitrite was responsible for the desired therapeutic action. In the majority of cases, nitrite was found in the urine. Ayman 2 recently reported that the drug had no demonstrable effect on the blood pressure. Several cases of nitrite poisoning following ingestion of bismuth subnitrate have been reported. 3 , 4 In most cases, large quantities had been given for x-ray examination to patients with open intestinal lesions or hypersensitive mucosae.
If bismuth subnitrate is partially decomposed with absorption of nitrite, the absorption of some bismuth might be expected. The metal has been reported in the tissues and urine following ingestion of the subcarbonate. 5
It was planned to study the urinary excretion of bismuth, nitrate and nitrite in normal individuals receiving the amount of the subnitrate recommended by Stieglitz. The diet was not rigidly controlled, although variation from day to day was not great. Corned meats and large amounts of vegetables were avoided. 0.5 gm. of the drug was taken 3 times a day for a month. At the end of the period a purge of magnesium citrate cleared the intestinal tract as quickly and thoroughly as possible, and a short after-period was run. Bismuth determinations were made by the method of Leonard, 6 nitrates after Whalen, 7 and qualitative nitrite tests by the Gries (as modified by Hyman and Mann 8 ) and Fearon 9 procedures.
Within 2 days of the start of the bismuth subnitrate ingestion, the urinary nitrate nitrogen increased from 4.9 mg. to 57.8 mg. in 24 hours, or over 1000%, and remained at about 800% of the normal during the drug period.
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