Lead poisoning medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D.

Overview

The mainstay of treatment for lead poisoning is chelation therapy.

Although the most important part of treating lead poisoning is decreasing exposure to lead, pharmacologic medical therapy with chelating agents to decrease the existing BLL (blood lead levels) include:

Medical Therapy

Additionally, a comparative study of chelating agents showed that vitamin C (ascorbic acid), along with DMSA, CDTA and DMPS increased survival in an animal model of lead intoxication, while EDTA, N-acetyl-L-cysteine (NAC) and various other agents did not.[1] High serum levels of vitamin C have been associated with a decreased prevalence of elevated blood lead levels[2] and intervention with supplemental vitamin C was shown to markedly decrease lead levels in smokers (mean: 81 %). Authors hypothesize, however, that this effect might be due to an inhibition of lead absorption.[3]

Lead Poisoning

Adult The two most commonly used chelating agents we use in adults are CaNa2EDTA injected and DMSA (Succimer) administered orally.

    • BLL 5 to 19 mcg/dL: Discuss the health risks of chronic lead exposure. Lead exposure should be decreased. The risks at this level are higher for women who are or may become pregnant.
    • BLL 20 to 39 mcg/dL: Decrease lead exposure, due to long-term risks for effects on kidney function and cognitive function. Monitor BLL once a month.
    • BLL <40 mcg/dL : No evidence exist that chelation therapy at these levels decrease symptoms or reduces the risk of chronic disease.
    • BLL 40 to 49 mcg/dL:
  • Asymptomatic patients – Decrease lead exposures.
  • Symptomatic patients - DMSA (Succimer) administered orally.
    • BLL 50 to 79 mcg/dL: Remove from lead exposures. Patients with persisting BLL >50 mcg/dL and symptomatic after removal should undergo chelation therapy, unless there are contraindications.
    • BLL 80 to 100 mcg/dL: Acute symptoms, such as abdominal pain, constipation, headache, and anemia, generally respond well to lowering of BLL with chelation therapy. Patients may be very symptomatic at this level and these patients may require inpatient chelation therapy with parenteral CaNa2EDTA.
    • BLL >100 mcg/dL: Inpatient chelation therapy with parenteral CaNa2EDTA.


Pediatric

    • BLL <5 mcg/dL: Mean (BLL) for children 1-5 years old is less than 2 mcg/dL. Review risk factors for lead poisoning with parents. Repeat BLL in 6-12 months if the child is at high risk.. Ensure levels are done at 1 and 2 years of age. For children screened at age <12 months, retest in 3-6 months.
    • BLL 5-14 mcg/dL: Retest the BLL in 3 months. Identify potential sources of exposures.
    • BLL 15-44 mcg/dL: Repeat venous sample within 1-4 weeks.
    • BLL >44 mcg/dL: The CDC 0Center for Disease Control) recommend that asymptomatic children with BLL 45 mcg/dL (2.17 micromol/L) receive chelation therapy, preferrably with succimer. If succimer is contraindicated, not tolerated, or causes, significant adverse reactions, then CaNa2EDTA is suggested. Treatment should begin as soon as possible after the BLL is confirmed and only when the child is in a lead safe environment.


  • SUCCIMER Dosages
  • Adolescents

> 45 kg: 500 mg/dose PO. 35—44 kg: 400 mg/dose PO. 24—34 kg: 300 mg/dose PO. 16—23 kg: 200 mg/dose PO. 8—15 kg: 100 mg/dose PO.

  • Children

> 45 kg: 500 mg/dose PO. 35—44 kg: 400 mg/dose PO. 24—34 kg: 300 mg/dose PO. 16—23 kg: 200 mg/dose PO. 8—15 kg: 100 mg/dose PO. The mg dose is given every 8 hours for days 1—5 and every 12 hours for days 6—19.

  • SUCCIMER Contraindications

Neutropenia

Dehydration

Dialysis Hypovolemia

Renal failure

Renal impairment

Hepatic disease

Pregnancy

Breast-feeding

Infants, neonates

References

  1. Llobet JM, Domingo JL, Paternain JL, Corbella J (1990). "Treatment of acute lead intoxication. A quantitative comparison of a number of chelating agents". Arch Environ Contam Toxicol. 19 (2): 185&ndash, 9. doi:10.1007/BF01056085. PMID 2322019.
  2. Simon JA, Hudes ES (1999). "Relationship of ascorbic acid to blood lead levels". JAMA. 281 (24): 2289&ndash, 93. doi:10.1001/jama.281.24.2289. PMID 10386552.
  3. Dawson E, Evans D, Harris W, Teter M, McGanity W (1999). "The effect of ascorbic acid supplementation on the blood lead levels of smokers". J Am Coll Nutr. 18 (2): 166&ndash, 70. PMID 10204833.

https://www.cdc.gov/nceh/lead/publications/books/plpyc/chapter7.htm


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