A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage.
Journal
Journal of medical toxicology : official journal of the American College of Medical Toxicology
ISSN: 1937-6995
Titre abrégé: J Med Toxicol
Pays: United States
ID NLM: 101284598
Informations de publication
Date de publication:
16 Oct 2023
16 Oct 2023
Historique:
received:
22
06
2023
accepted:
08
09
2023
revised:
07
09
2023
medline:
16
10
2023
pubmed:
16
10
2023
entrez:
16
10
2023
Statut:
aheadofprint
Résumé
For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNa The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care.
Identifiants
pubmed: 37843802
doi: 10.1007/s13181-023-00970-2
pii: 10.1007/s13181-023-00970-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. American College of Medical Toxicology.
Références
Arnold J, Morgan B. Management of lead encephalopathy with DMSA after exposure to lead-contaminated moonshine. J Med Toxicol. 2015;11(4):464–7. https://doi.org/10.1007/s13181-015-0493-9\ .
doi: 10.1007/s13181-015-0493-9\
pubmed: 26245877
pmcid: 4675610
Thurtle N, Greig J, Cooney L, Amitai Y, Ariti C, Brown MJ, et al. Description of 3,180 courses of chelation with dimercaptosuccinic acid in children ≤5 y with severe lead poisoning in Zamfara, Northern Nigeria: a retrospective analysis of programme data. PLoS Med. 2014;11(10) https://doi.org/10.1371/journal.pmed.1001739 .
Ennis JM, Harrison HE. Treatment of lead encephalopathy with bal(2.3-dimercaptopropanol). Pediatrics. 1950;5(5):853–68. https://doi.org/10.1542/peds.5.5.853 .
doi: 10.1542/peds.5.5.853
pubmed: 15417286
Keshri S, Goel AK, Garg AK. Reversal of acute lead encephalopathy in a child. Cureus. 2021; https://doi.org/10.7759/cureus.15155 .
Chisolm JJ. The use of chelating agents in the treatment of acute and chronic lead intoxication in childhood. J Pediatr. 1968;73(1):1–38. https://doi.org/10.1016/s0022-3476(68)80036-8 .
doi: 10.1016/s0022-3476(68)80036-8
pubmed: 4969284
Ryder HW, Cholak J, Kehoe RA. Influence of dithiopropanol (BAL) on human lead metabolism. Science. 1947;106(2742):63–4. https://doi.org/10.1126/science.106.2742.63 .
doi: 10.1126/science.106.2742.63
pubmed: 17820732
Germuth F, Eagle H. The efficacy of BAL (2, 3-dimercaptopropanol) in the treatment of experimental lead poisoning in rabbits. J Pharmacol Exp Therap. 1948;92(4):397–410.
Giannattasio R, Pirozzi M, Bedo A, Jennings K. Bal therapy in chronic lead poisoning. Pediatrics. 1952;10(5):603–11. https://doi.org/10.1542/peds.10.5.603 .
doi: 10.1542/peds.10.5.603
pubmed: 13003406
Mazer-Amirshahi M, Fox ER, Routsolias JC, Johnson-Arbor K, Mycyk MB. How can we “get the lead out” without chelators? J Med Toxicol. 2021;17(4):330–2. https://doi.org/10.1007/s13181-021-00848-1 .
doi: 10.1007/s13181-021-00848-1
pubmed: 34031804
pmcid: 8143065
Brown MJ, Willis T, Omalu B, Leiker R. Deaths resulting from hypocalcemia after administration of Edetate Disodium: 2003-2005. Pediatrics. 2006;118(2) https://doi.org/10.1542/peds.2006-0858 .
King AM, Danagoulian S, Lynch M, Menke N, Mu Y, Saul M, et al. The effect of a medical toxicology inpatient service in an academic tertiary care referral center. J Med Toxicol. 2018;15(1):12–21. https://doi.org/10.1007/s13181-018-0684-2 .
doi: 10.1007/s13181-018-0684-2
pubmed: 30353414
pmcid: 6314930
Davis KM. Lead poisoning prevention efforts in high-risk environments: Follow-up testing rates among preschool children in Flint, Michigan, 2013–2015. J Racial Ethn Health Disparities. 2020;8(1):199–209. https://doi.org/10.1007/s40615-020-00772-0 .
doi: 10.1007/s40615-020-00772-0
pubmed: 32514782
Neuwirth LS. Resurgent lead poisoning and renewed public attention towards environmental social justice issues: a review of current efforts and call to revitalize primary and secondary lead poisoning prevention for pregnant women, lactating mothers, and children within the U.S. Int J Occup Environ Health. 2018;24(3–4):86–100. https://doi.org/10.1080/10773525.2018.1507291 .
doi: 10.1080/10773525.2018.1507291
pubmed: 30139311
pmcid: 6237172