China
Africa
Explore chapters and articles related to this topic
Neurotoxicology
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Sean D. McCann, Trevonne M. Thompson
Diagnosis and monitoring of lead poisoning rely on venous blood lead level measurements. Unlike screening for other metal toxicities, these levels are typically more readily available, reliable, and should be drawn on any patient with suspected exposure including any children with notable hand-to-mouth behavior. Pediatricians regularly perform lead screening by capillary blood lead level measurements, which, if elevated, are then confirmed by venous blood sample. The primary treatment of lead poisoning is identification and removal of the source of the exposure from the patient. Involvement of local public health department is a critical component of this evaluation, and reporting of elevated venous lead levels to health departments is required by law in nearly every US state. Chelation therapy can be performed for lead poisoning using oral succimer, or in severe cases (defined by the presence of encephalopathy or lead concentration > 70 µg/dL) intramuscular British anti-Lewisite (BAL) or intravenous calcium disodium edetate (CaNa2EDTA). Chelation therapy will gradually reduce lead levels but has not been shown to change neurocognitive outcomes in lead poisoned patients. Chelators are nonspecific and can also chelate essential trace metals from the body, in addition to having a variety of potential adverse effects. Therefore, chelation therapy should be guided by a health care provider familiar with these effects such as a medical toxicologist, local poison center, or pediatrician with experience in managing lead poisoning.
Inhalational Durg Abuse
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Jacob Loke, Richard Rowley, Herbert D. Kleber, Peter Jatlow
Chelation therapy has been used for the treatment of the tetraethyl lead toxicity and may decrease the blood lead level and improve some of the neurologic symptoms. Dimercaprol, calcium disodium edetate, and penicillamine are some of the chelating agents used (Fortenberry, 1985).
Toxicology
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Start aggressive fluid resuscitation in patients with signs of gastrointestinal or systemic toxicity, and institute decontamination and chelation measures. Discuss these with the senior ED doctor or a clinical toxicologist: Decontamination: do not administer charcoal or attempt to induce vomitingperform whole bowel irrigation if there are significant numbers of tablets beyond the pylorus.Chelation therapy: start a desferrioxamine infusion at 2 mg/kg per h and rapidly increase to 15 mg/kg per h in severe casesreduce the infusion rate if hypotension occurs.
Unregulated supplement use causing insidious lead toxicity
Published in Baylor University Medical Center Proceedings, 2023
Grant Manh-tri Pham, Anuj Sharma
New immigrants coming to America from all parts of the world bring their traditions and folk medicines with them. Immigration from India has increased along with ayurvedic supplement use.4 One study showed that at least a quarter of traditional medicine in India had lead levels above the World Health Organization recommended threshold.5 Another study showed that not only is lead contaminated in many of these ayurvedic supplements from South Asia, but also other heavy metals such as cadmium, arsenic, or mercury. Moreover, research from the Centers for Disease Control and Prevention showed 12 cases of lead-tainted ayurvedic in five states from 2000 to 2003. Case reports from a similar time frame concur with this assessment, with four individuals with lead intoxication due to ayurvedic supplementation. All presented to the emergency department with vague abdominal symptoms and lead levels >80 µg/dL. Chelation therapy was successfully initiated in those cases.7 Furthermore, a cross-sectional analysis using data from the National Health and Nutrition Examination Survey from 1999 to 2004 showed that participants using ayurvedic supplements had blood lead levels 24% higher than those of nonusers.8
The influence of erdosteine administration on lead-induced oxidative stress in rat muscle
Published in Drug and Chemical Toxicology, 2022
Michał Dobrakowski, Anna Machoń-Grecka, Przemysław Nowak, Patrycja Szczęsny, Maciej Maciejczyk, Aleksandra Kasperczyk, Tomasz Pryzwan, Sławomir Kasperczyk
Chelation therapy can be regarded as a classic method of lead poisoning treatment. Due to many side-effects, such as renal and cardiac problems, nausea, vomiting, diarrhea, abdominal pain, skin lesions, glossitis, leukopenia, and thrombocytopenia, sourcing for potentially safe alternatives to chelators for ameliorating lead toxicity is a matter of great importance (Lamidi and Akefe 2017). Therefore, we aimed to investigate administration of a thiol containing antioxidant, N-acetylcysteine (NAC), to verify its potential as an alternative therapy for lead poisoning. We showed that NAC administered orally in doses 200, 400 and 800 mg per day was able to reduce lead-induced oxidative stress in a dose-dependent manner, to normalize antioxidant enzyme activities in blood cells (Kasperczyk et al. 2014a), and to normalize glutathione metabolism (Kasperczyk et al. 2013) in workers chronically exposed to lead. Besides, elevated level of α-tocopherol and decreased level of homocysteine could be regarded as other beneficial effects of the evaluated therapy (Kasperczyk et al. 2014b, 2016).
Drug safety in thalassemia: lessons from the present and directions for the future
Published in Expert Opinion on Drug Safety, 2021
Laura Grech, Janet Sultana, Karen Borg, Joseph Borg
Current treatment for transfusion-dependent thalassemia (TDT) consists of regular blood transfusions to maintain hemoglobin levels between 9 and 10 g/dL [7] while non-transfusion dependent thalassemia (NTDT) patients require transfusions only when suffering from infections, during pregnancy or for surgical procedures [8]. Transfusions can give rise to a number of complications such as alloimmunization and iron overload in vital organs. In β-thalassemia major, if left untreated, iron overload is fatal in early life as a result of cardiac failure [9]. The introduction of regular transfusions followed by iron-chelating therapy has led to improved survival in β-thalassemia major. Studies have shown that optimal outcomes are achieved when chelation therapy is tailored according to patient requirements [7]. In the EPIC study, it was shown that initial iron chelating doses and subsequent titration are best guided by trends in serum ferritin and other safety markers including serum creatinine, liver function tests, cytopenia and hypersensitivity reactions [10]. It is therefore important that clinicians keep a record of patients’ transfusion history and the iron load as these parameters are used to guide treatment decisions including the type of iron-chelating drug used and the dose escalation [11].