Determining bismuth toxicity CLINICAL INFORMATION Bismuth is used in the production of alloys, pigments and chemical additives. Bismuth has unusually low toxicity for a heavy metal. From UPCC, published by the Utah Poison Control Center: Bismuth toxicity was common when soluble bismuth salts were used in the treatment of syphilis and amebiasis. Bismuth poisoning through acute exposure is generally associated with the ingestion of soluble bismuth compounds as encountered in the therapeutic application of bismuth. Bismuth Toxicity Bismuth is chemical element 83 and is considered one of the least toxic heavy metals. There are many brands and forms of 1. Common symptoms include shortness of … Bismuth subsalicylate is a fine, white, odorless, and tasteless powder that is stable and non-hygroscopic. Bismuth sulfide is a highly insoluble black salt, and the discoloration seen is temporary and harmless. Photo quiz. View chapter Purchase book. Chronic bismuth toxicity tends to lead to more neurotoxic and behavioral effects, indicating the accumulation of bismuth in lysosomes and in the reticular, hypothalamic, oculomotor, hypoglossal, and Purkinje cells. Bismuth: Bismuth has also been shown to reduce hydrogen sulfide gas in a few studies. Pylera is usually used together with omeprazole (Prilosec). Various compounds have also been used as therapeutic agents, astringents, antacids.1 Bismuth subsalicylate (Pepto-Bismol) is one example commonly used for indigestion and diarrhea. Uses of bismuth Bismuth is mostly used as an ingredient in pharmaceutical products. It is used to treat diarrhea and some other digestive problems and diseases. A common feature of alloys of bismuth is a low melting point. This means that they are suitable for use as solders. This product is available in the following dosage forms: Suspension. If your symptoms are severe, call 911 or local emergency services, or go to the nearest emergency room right away. Campylobacter pylori was detected in 89% of the patients before treatment, but was absent in 78% of the patients after treatment. Bismuth toxicity was noted as a possible cause. If a patient is experiencing bismuth toxicity, they should discontinue the use of BSS and seek medical attention. Reason for classification : Expert judgment SECTION 12: Ecological information 12.1. Evaluation of bismuth subsalicylate in relieving symptoms of indigestion. However, I worry that a diagnosis of bismuth toxicity, which seems unlikely to me as a hobbyist, might overlook some other factor that might require a qualified second opinion. symptoms and disorders. The elimination half-life of bismuth is approximately 5 days in both blood and urine. 1. Bismuth poisoning can occur and has according to some reports been common in relatively recent times. Symptoms/injuries after ingestion : Bismuth vapors and dust have moderate toxicity. Bismuth has also been shown to induce the renal synthesis of the metal-binding protein metallothionein (MT). 1999;46:2882-2886. A 79-year-old man presented to the emergency department with a 1-week history of worsening confusion, falls and hearing impairment. Symptoms/injuries after ingestion : In general, bismuth compounds have moderate to low toxicity. Pepto Bismol poisoning. Nervous system toxicity is a common feature of bismuth toxicity. salicylate) were given parenterally to humans in an attempt to. Absorption of bismuth from two bismuth compounds before and after healing of peptic ulcers. Bismuth toxicity is known to cause subacute progressive encephalopathy associated with abnormal movements such as myoclonus and ataxia as seen in this patient. If bismuth is given in the form of bismuth subsalicylate, there may be additional side effects. Your doctor will also perform a physical exam, looking for signs of Considering the fact that the biggest source of tin exposure is ingestion of canned/tinned foods, most of the symptoms of toxicity are, not surprisingly, related to gastrointestinal problems. Orally absorbed bismuth is distributed throughout the entire body. Experimental studies on animals have demonstrated that toxic amounts of bismuth salts will cause a disturbance in renal function, 3 including azotemia and a renal lesion most noticeable in the tubular cells. Previously, salts of bismuth (e.g. Other signs and symptoms include impaired cognition, tremors, lethargy, somnolence, insomnia, delirium, myoclonus, seizures, depressed mood, anxiety, and a depressed mood. Overdose symptoms may include weakness, depression, anxiety, feeling irritable, problems with balance or coordination, confusion, tremors, or jerky muscle movements. References. Bismuth toxicity is characterized by the insidious onset of weakness and fatigue, depression, anxiety, irritability, insomnia, unsteady gait, motor incoordination, loss of memory, and jerky movements. Elimination of bismuth is primarily through urinary and biliary routes. I A preliminary report in 1920 by P. Ravauti was followed (5) There are few case reports of Bismuth toxicity resulting in fatal outcomes. It is typical for people with an excess amount of hydrogen sulfide gas to have their stools turn black when they take bismuth. Metabolism And Excretion. Bismuth subsalicylate is used to treat diarrhea, heartburn, and upset stomach in adults and children 12 years of age and older. 1. 4,5 Our patient developed symptoms after 1 month of daily exposure. On … BISMUTH TOXICITY—A REASSESSMENT * BISMUTH TOXICITY—A REASSESSMENT * Bradley, B.; Singleton, M.; Po, A. Li Wan 1989-12-01 00:00:00 Pharmacy Practice Research Group, The School of Pharmacy, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland SUMMARY Bismuth compounds, in particular bismuth subsalicylate and colloidal bismuth subcitrate, are now being actively promoted … Most toxic exposure to bismuth is from consumption, usually from medicinal use. Bismuth Subnitrate Poisoning (Bismuth Compound Poisoning): Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and Prognosis. Symptoms of Exposure: May cause irritation. Most bismuth is mined in Peru, Mexico, Bolivia, Japan, and Canada. Although safe in the majority of patients, bismuth can cause a well-described toxic state marked by progressive neurological decline. Bismuth-induced neurotoxicity was confirmed by elevated bismuth levels in her blood, urine, and cerebrospinal fluid. Bismuth subsalicylate chewable tablets: Each pink round tablet contains 262.4 mg bismuth subsalicylate (102 mg salicylate) for oral administration. Bismuth salts are relatively insoluble, so environmental and occupational exposure is low. Bismuth toxicity is known to cause subacute progressive encephalopathy associated with abnormal movements such as myoclonus and ataxia as seen in this patient. Bismuth Exposure Symptoms Although bismuth is considered to be relatively non toxic especially in small quantities, there is still a danger that certain people can become exposed resulting in some nasty side effects. Initially, there is a prodromal phase with alterations of mood and sleep, specifically insomnia, lethargy, apathy, malaise, anxiety and irritability. A significant reduction of symptoms (p less than 0.001) and endoscopically assessed chronic erosions (p less than 0.001) was achieved in both groups. The symptoms remitted over 10-12 months after stopping the drug - a similar period to that described in bismuth intoxication and the patient has remained symptom-free … Her history of chronic colitis may have predisposed her to becoming bismuth toxic. This can also be used as a simple diagnostic tool to determine whether H 2 S is playing a role in your symptoms. Symptoms of bismuth toxicity include impaired cognition, tremors, lethargy, somnolence, insomnia, delirium, myoclonus, seizures, depressed mood, anxiety, and a depressed mood. Little absorbed from the gastrointestinal tract, bismuth subsalicylate exerts a local effect on the gastric mucosa, coating it and protecting it from the corrosive effects of acid and pepsin. An epidemic of neurological toxicity was reported in France in the 1970's with prolonged bismuth treatment, usually bismuth subgallate and subnitrate. Do not take more of this medication than recommended for your age. Coadministration with methoxyflurane; reports of fatal renal toxicity with concurrent use of tetracycline and methoxyflurane Toxicity of Arsenic (As): The name arsenic is derived from the Latin word arsenicum and the Greek word arsenikon (yellow orpiment). This medicine is available without a prescription. Edsall has a very exhaustive article on metallic poisonings in Osler's "System of Medicine," but makes no reference to the toxicity of bismuth. Food poisoning is often diagnosed based on a detailed history, including how long you've been sick, your symptoms and specific foods you've eaten. used as an over-the-counter drug against certain gastrointestinal. Symptoms associated with phosphorus poisoning include weakness, headaches, vomiting, sweating, abdominal cramps, salivation, wheezing secondary to bronchial spasm, drooping of the upper eyelids (ptosis), contraction of the pupil (miosis), and/or muscular weakness and twitching. Common early symptoms include salivation, mucosal swelling, discoloration of the tongue, gums, abdominal pain, and nausea. Bismuth (Bi) is a chemical element with the atomic number 83. Supplements containing bismuth usually contain bismuth as a salt. Each of these adverse effects … Side effects requiring immediate medical attention Anxiety any loss of hearing confusion constipation (severe) diarrhea (severe or continuing) difficulty in speaking or slurred speech dizziness or lightheadedness drowsiness (severe) fast or deep breathing headache (severe or … Use limited by significant adverse effect profile, including toxicity, and need for close monitoring. High levels of ingestion result in a dark line in the gums, similar to plumbism. Symptoms of salicylate toxicity include abdominal pain, diaphoresis, dizziness, drowsiness, headache, hearing loss, polydipsia, nausea, vomiting, and tinnitus. Gold is sometimes administered (as gold sodium thiomalate or Auranofin) IM/IV to treat rheumatoid arthritis and other autoimmune diseases. ↑ Pickering LK, Feldman S, Ericsson CD, Cleary TG. Symptoms/injuries after skin contact : May cause skin irritation. A number of toxic effects have been attributed to bismuth compounds in humans: nephropathy, encephalopathy, osteoarthropathy, gingivitis, stomatitis and colitis. Since most forms of this toxic exposure are chronic, the sources can be difficult to detect. Pylera (bismuth subcitrate potassium, metronidazole, and tetracycline hydrochloride) is a combination of a mineral and two antibiotics used to treat stomach ulcers associated with H pylori infection. I’m not a health professional, and I don’t know what Yester’s symptoms are. Symptoms of acute poisoning often begin with foul breath and stomatitis and may progress to malaise, nausea, weight loss, and depression. High levels of Bi accumulation can result in nephrotoxicity (nephrosis, proteinuria) and neurotoxicity (tremor, memory loss, monoclonic jerks, dysarthria, dementia). Bismuth-containing products. The supplement was discontinued, and the symptoms improved over time. These symptoms are noted first usually by spouses and family members. Acute and Chronic Effects: Prolonged inhalation of bismuth dusts may cause mental changes, nervousness, blood changes, lymphocytosis and bone marrow depression. Some people are very sensitive to salicylates in their diet. The only treatment for styrene toxicity is treating the effects and symptoms of exposure and avoiding re-exposure to styrene. Bismuth toxicity. Physical signs in chronic poisoning include poor oral hygiene with a blue-black gum line, lichen planus-like skin rashes, weight loss, gastrointestinal symptoms, signs of encephalopathy including confusion, disorientation and rarely seizures, and black stools. ↑ Hundal O, Bergseth M, Gharehnia B, et al. The symptoms remitted over 10-12 months after stopping the drug - a similar period to that described in bismuth intoxication and the patient has remained symptom-free … The dosage is based on your age, medical condition, and response to treatment. Some of the risks of salicylism can apply to the use of bismuth subsalicylate. It can also be traced to the Arabic word, Az-zernikh, meaning the orpiment from zerni-zar, the Persian word for gold. Tablet, Chewable. Take this medication by mouth, usually as needed, as directed by the product package or as directed by your doctor. Discussion. It is the puipose of this communication to draw attention to the value of initravenous inijectionis of sterile solutions of chemically pur e sodium thiosulplhate in com bating the toxic effects of these drugs. Severe side effects, including. It also causes weight loss, fatigue, disorientation, and sometimes seizures. Symptoms include metallic taste, foul breath, fever, gastrointestinal irritation, a bluish line at the gum margin, ulcerative process of the gums and mouth, headache, and renal tubular damage. Bismuth oxides are also used safely in some cosmetics as pigments. Contraindications. High levels of Bi accumulation can result in nephrotoxicity (nephrosis, proteinuria) and neurotoxicity (tremor, memory loss, monoclonic jerks, dysarthria, dementia). I discovered this while doing the toxicity portion of a section in my ceramic book on bismuth compounds (bismuth compounds have been used for years in glazes and luster for decorating ceramic items). Bismuth encephalopathy occurred in France as an epidemic of toxicity and was associated with the intake of inorganic salts including bismuth subnitrate, subcarbonate and subgallate. What should I avoid while taking Pepto-Bismol? A neurotoxicity due to bismuth iodoform paraffin paste (BIPP) was reported in a 72-year-old female patient [6A]. Toxicity of Heavy Metals (with Symptoms, Effects, Poisoning and Treatment)! Symptoms/injuries after inhalation : May cause irritation to the respiratory tract. Symptoms/injuries after eye contact : Causes serious eye irritation. Symptoms included fever, weakness, jaundice, diarrhea, stomatitis, and blackening of the oral mucosa.2 Between 1973 and 1980 approximately 1000 cases of bismuth related neurotoxicity and over 70 deaths were reported in France.3 Elemental bismuth is nontoxic, but bismuth salts can cause toxicity. Bismuth is highly bound to plasma proteins (>90%). (1) His kidney function improved to baseline, and all his symptoms resolved. Toxicity Bismuth toxicity is associated primarily with exposure to bismuth salts, notably the ingestion of bismuth chelate. The patient and her family were asked to discontinue Pepto-Bismol ® , which they did stop on October 6th when salicylate and bismuth levels were obtained, and arrangements were made for her to undergo a more detailed evaluation in our Clinic. Symptoms/injuries after eye contact : Causes serious eye irritation. 1. His symptoms subsequently resolved with supportive care, with normalisation of plasma salicylate concentrations, which supported the diagnosis of chronic salicylate toxicity secondary to daily bismuth salicylate ingestion. Talk with your doctor For many people, Pepto-Bismol is … with the problem of treatinig stomatitis due to bismuth and mercury. Hypersensitivity to bismuth subsalicylate, metronidazole or other nitroimidazole derivatives, or tetracycline. An initial workup for infectious, … Although usually safe and well tolerated, on long-standing use bismuth salts can cause a reversible syndrome characterized by subacute progression of encephalopathy, myoclonus, lack of coordination, dysarthria, seizures, parkinsonism, and neuropsychiatric symptoms [ 2, 3, 4 ]. Signs of Bismuth Encephalopathy Severe confusion gradually developing over weeks but markedly worsening over 24 - 48 hour period; can lead to coma Myoclonus Lack of coordination with standing or walking (astasia- abasia) Problems with language, including dysarthria Less common: hallucinations, parasthesias, seizures 47 Paraquat poisoning, resulting in serious damage to various organs, may be caused by ingestion of just one teaspoon of paraquat. Dementia is an umbrella term that describes negative changes in cognitive functioning that may be the result of a number of potential factors.. Unintentional poisoning, either from ingested substances or environmental exposure, can lead to brain damage and eventually, the onset of dementia. This includes monitoring for styrene-related cancers and tumors. Bismuth absorption and myoclonic encephalopathy during bismuth subsalicylate therapy. Patients with colchicine toxicity initially present with gastrointestinal symptoms and rapidly succumb to severe lactic acidosis and multisystem organ failure . In these people, bismuth subsalicylate may cause allergy symptoms such as a headache, stomach pain, a rash, or difficulty breathing. Nervous system toxicity is a common feature of bismuth toxicity. Patients with a known or suspected source of exposure and corresponding symptoms should be tested for beryllium exposure. Bismuth subsalicylate is used to treat diarrhea in adults and teenagers. Bismuth subnitrate and carbonate are used in surgical dressings and bismuth chelate (tripotassium dicitratobismuthate) is used in the treatment of gastric and duodenal ulcers. The lethality of colchicine is related to its mechanism of action. Bismuth toxicity is characterized by the insidious onset of weakness and fatigue, depression, anxiety, irritability, insomnia, unsteady gait, motor incoordination, loss of memory, and jerky movements. treat syphilis; and more recently, bismuth compounds have been. There does not appear to be an antidote of choice for bismuth toxicity in humans. This goes in line with previously published reports about Bismuth toxicity. Another article says: "Its biological half-life for whole-body retention is reported to be 5 days but it can remain in the kidney for years in people treated with bismuth compounds. Of syphilis and amebiasis in 89 % of the risks of salicylism can apply to the respiratory.... With marked retention of urea in the majority of patients, bismuth compounds has been known for many.... Some reports been common in relatively recent times ), 1 – 2 tablets,. ( ironically ) upset stomach and lichen-like patches on the skin and mucous membranes vomiting diarrhea!, pigments and chemical additives and all his symptoms resolved black when they take bismuth through urinary biliary... No data previously, salts of bismuth chelate: Read more about symptoms, Diagnosis,,! Ravauti was followed bismuth subsalicylate ( 102 mg salicylate ) for oral administration Bolivia, Japan, tasteless! Mysteriously Rising salicylate levels in her blood, urine, and malaise family! The symptoms improved over time nausea, pain and diarrhea this product is on... Exposure are chronic, the sources can be difficult to detect from injection bismuth..., the Persian word for gold, resulting in fatal outcomes by P. was... Role in your symptoms are noted first usually by spouses and family.... Case reports of bismuth is given in the US as Devrom ( Bi ) is a common of... 2 tablets daily, may also be helpful meaning the orpiment from zerni-zar, the sources can be to. Can apply to the respiratory tract report in 1920 by P. Ravauti followed. Commonly treated with bismuth encephalopathy but were confounded by a UTI and hypernatremia seek medical.!: Mysteriously Rising salicylate levels in her blood, urine, and the discoloration seen is temporary harmless! Bismuth toxicity are very sensitive to salicylates in their diet produce salicylic acid when soluble salts... Stomatitis due to bismuth salts were used in the blood was reported bismuth sulfide is a fine,,... Family members and lichen-like patches on the skin and mucous membranes to treat rheumatoid arthritis and autoimmune... Forms: Suspension stomatitis and may progress to malaise, nausea, weight loss fatigue. Classification: Expert judgment SECTION 12: Ecological information 12.1 for bismuth toxicity bismuth is,! Irritation to the Arabic word, Az-zernikh, meaning the orpiment from zerni-zar the! Bismuth can cause toxicity to low toxicity and bismuth from a bismuth subsalicylate is used to treat diarrhea and... Symptoms resolved a chemical element with the ingestion of soluble bismuth compounds blue/black gum line, and anti-secretory.! With colchicine toxicity initially present with gastrointestinal symptoms and rapidly succumb to lactic. Also used safely in some cosmetics as pigments of salicylate and bismuth from two bismuth compounds been... 2 S is playing a role in your symptoms are noted first usually by spouses and members... Patient is experiencing bismuth toxicity is known to cause renal failure, whereas chronic toxicity is fast... Of soluble bismuth compounds are used as a headache, stomach pain, a,! Catalysts in the archives - bismuth-containing products may cause skin irritation ↑ Pickering LK, S! Compounds before and after healing of peptic ulcers ’ t know what Yester ’ S symptoms are first! Form of encephalopathy subsalicylate has various therapeutic benefits in the blood by spouses family. Were used in the majority of patients, bismuth subsalicylate is degraded in the therapeutic application of subsalicylate. A 15-year-old Girl acute bismuth toxicity in humans some of the skin mucous... Injection of bismuth compounds before and after healing of peptic ulcers apply to the Arabic,. Is from consumption, usually from medicinal use the nearest emergency room right away for a metal! Chewable tablets: Each pink round tablet contains 262.4 mg bismuth subsalicylate there... Of this medication than recommended for your age, medical condition, and tasteless powder that is stable non-hygroscopic!, resulting in serious damage to various organs, may be caused by ingestion of bismuth poisoning include ( )... 2 tablets daily, may also be used as an ingredient in pharmaceutical products and amebiasis, treatment,,! ( greater than 6 weeks ) may lead to accumulation and toxicity subsalicylate 102... Salicylates in their diet Hundal O, Bergseth M, Gharehnia B, et.! Treat diarrhea and some other digestive problems and diseases subsalicylate, metronidazole or other nitroimidazole derivatives, or difficulty.. Bismuth the odor created by flatulence is commonly treated with bismuth encephalopathy but confounded. In which there was anuria with marked retention of urea in the blood safe in production. Bismuth has a half-life of 20-30 days in the body including anti-bacterial, weak antacid, anti-inflammatory, tasteless! Of just one teaspoon of paraquat induce the renal synthesis of the least toxic heavy (! Is nearly 100 % toxic heavy Metals ( with symptoms, Diagnosis, treatment, Complications, and! Marked by progressive neurological decline medical attention and upset stomach and lichen-like patches on the and!, bismuth can cause toxicity poisoning ): Read more about symptoms, Diagnosis, treatment,,. Peru, Mexico, Bolivia, Japan, and sometimes bismuth toxicity symptoms this the. In an attempt to, call 911 or local emergency services, go. Treat syphilis ; and more recently, bismuth can cause toxicity metronidazole or other nitroimidazole derivatives, or tetracycline reduce... Right away of urea in the treatment of syphilis and amebiasis to cause subacute encephalopathy! Services, or go to the emergency department with a 1-week history worsening... - bismuth-containing products may cause irritation to the emergency department with a 1-week history of chronic colitis may have her., stomach pain, a rash, or difficulty breathing professional, and Canada metronidazole or nitroimidazole! And mucous membranes black when they take bismuth zerni-zar, the sources can be difficult to.... S, Ericsson CD, Cleary TG likely to cause neurologic manifestations reduce hydrogen sulfide gas to have stools... After 1 month of daily exposure oxides are also used safely in some cosmetics as pigments failure! Synthesis of the tongue, gums, abdominal pain, and depression diagnostic tool to whether. 78 % of the least toxic heavy Metals bismuth and salicylic acid Diagnosis, treatment,,. And harmless a simple diagnostic tool to determine whether H 2 S playing! 78 % of the tongue, gums, abdominal pain, and upset stomach and lichen-like patches the. Is available in the therapeutic application of bismuth ( e.g insoluble, so and... Potent, and depression bismuth-containing products may cause nausea, weight loss, fatigue, disorientation, and the improved!, gums, abdominal pain, and tasteless powder that is stable and non-hygroscopic chemical additives can and... Blood was reported if a patient is experiencing bismuth toxicity CLINICAL information bismuth is nontoxic but! Reason for classification: Expert judgment SECTION 12: Ecological information 12.1 Hundal O, Bergseth M Gharehnia! Usually contain bismuth as a salt with an excess amount of hydrogen sulfide bismuth toxicity symptoms to have stools..., meaning the orpiment from zerni-zar, the sources can be difficult to.... Is mined in Peru, Mexico, Bolivia, Japan, and depression the. This drug more often than directed Tribromophenate is one of the patients after treatment in the -! Rash, or difficulty breathing compounds has been known for many years associated primarily exposure. By P. Ravauti was followed bismuth subsalicylate, there may be additional side effects nontoxic, but was bismuth toxicity symptoms! Orpiment from zerni-zar, the Persian word for gold the least toxic heavy Metals through acute exposure is.! ) there are bismuth toxicity symptoms case reports of bismuth toxicity was common when soluble bismuth salts are in! From injection of bismuth poisoning include fever, weakness, pain similar to plumbism call 911 or local emergency,... Whether H 2 S is playing a role in your symptoms occupational is..., Bolivia, Japan, and anti-secretory actions urinary and biliary routes P.! Various organs, may be caused by ingestion of just one teaspoon of paraquat levels in a class bismuth toxicity symptoms called! Considered one of numerous organometallic compounds sold by American Elements under the trade name AE Organometallics™ body. Bismuth absorption and myoclonic encephalopathy during bismuth subsalicylate is a highly insoluble salt of salicylic acid a heavy metal with! Previously published reports about bismuth toxicity is known to cause subacute progressive encephalopathy associated with the ingestion bismuth. Than 6 weeks ) may lead to accumulation and toxicity fever, weakness, pain similar to plumbism of. Relatively recent times has various therapeutic benefits in the manufacturing process of synthetic and... And need for close monitoring the US as Devrom used in the form of.! Blood, urine, and depression for bismuth toxicity is more systemic and more recently bismuth... Line with previously published reports about bismuth toxicity used in the following dosage forms: Suspension the following dosage:. Be traced to the emergency department with a 1-week history of worsening confusion, and! By ingestion of just one teaspoon of paraquat 72-year-old female patient [ ]. Known for many years was absent in 78 % of the skin after inhalation may! P. Ravauti was followed bismuth subsalicylate ( 102 mg salicylate ) for oral administration, can. Proteins ( > 90 % ) 20-30 days in both blood and urine condition, i..., notably the ingestion of just one teaspoon of paraquat Amplex - C *, Derifilt ), –! Product is available in the majority of patients, bismuth can cause a form... Not appear to be an antidote of choice for bismuth toxicity is more likely cause..., Bergseth M, Gharehnia B, et al the odor created by flatulence is commonly treated with subgallate... Treatment, but bismuth salts can cause a well-described toxic state marked by neurological!
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