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Managing Pain in the Presence of Autoimmune Disease
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Provocative heavy metal tests use a chelating agent to pull these toxins from the fat stores and get them into the urine to be tested. A common chelating agent is DMSA at a dose of 1000 mg 1 hour after the first morning urine. After taking the chelating agent, urine collection is started for a set number of hours and can be done up to 24 hours, but I usually find 6 hours is sufficient to find what you are looking for.118–121
The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
If antenatal hydronephrosis is detected, postnatal investigation is recommended. Investigations include an ultrasound of the renal tract to assess renal size and morphology, and the degree of hydronephrosis. A micturating cystogram is required to exclude reflux (up to 30%), and to exclude posterior urethral valves in boys. A DMSA scan is often performed primarily to assess differential renal function and to exclude scarring. Local practice varies.
Pediatric urology
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Laurel Sofer, Emilie K. Johnson
DMSA scan provides differential renal function. In duplicated systems, a DMSA can delineate the relative function of the lower and upper pole moieties. VCUG may be used to evaluate for VUR before and/or after intervention. A MAG-3 scan may provide both functional and drainage information about the kidney in concern for obstruction. Functional estimation on a MAG-3 scan is slightly less accurate. Finally, while often unnecessary for the diagnosis, magnetic resonance urography can provide detailed anatomic images for challenging cases. It may be useful in identifying an occult ectopic ureter in an older child with incontinence.
Aging erythrocyte membranes as biomimetic nanometer carriers of liver-targeting chromium poisoning treatment
Published in Drug Delivery, 2021
Qing Yao, Guobao Yang, Hao Wang, Jingzhou Liu, Jinpeng Zheng, Bai Lv, Meiyan Yang, Yang Yang, Chunsheng Gao, Yongxue Guo
Dimercaptosuccinic acid (DMSA) is a new antidote developed in China. Compared to other antidotes, DMSA has many advantages, such as low toxicity, high bioavailability, and strong patient compliance, making it one of the first choices of heavy metal detoxification drugs (Graziano, 1986). After DMSA is administered, two active sulfhydryl groups in the molecule can seize the metals bound to the enzyme system in the tissue to form a stable water-soluble chelate, which is excreted in the urine, and enzymes are free and restore their function, thus, relieving the poisoning symptoms caused by heavy metals (Chen et al., 2014; Ma & Gong, 2014). However, the by-products produced by DMSA after entering the body cause more serious gastrointestinal reactions and hypercomplexation syndrome, which will affect the therapeutic effect and health of the patients. The long-term or one-time use of large doses of DMSA causes damage to liver and kidney function, including irreversible damage. To effectively reduce the damage caused by DMSA to the human liver and kidneys, we considered loading DMSA on nanoparticles and prepare them as biomimetic nanocarriers to achieve a slow-release, reduce the side effects of the drugs in the human body, and improve the bioavailability of the drugs.
Nephrotic syndrome caused by exposures to skin-lightening cosmetic products containing inorganic mercury
Published in Clinical Toxicology, 2020
Thomas Y. K. Chan, Alan P. L. Chan, H. L. Tang
The natural history, renal outcomes and impact of chelation therapy with or without steroids, the time to achieve remission of proteinuria (<150 mg/day) were documented. The therapeutic use of chelating agents, including unithiol (2,3-dimercapto-1-propanesulfonic acid (DMPS)) and succimer (dimercaptosuccinic acid (DMSA)), was recorded. Blood and urine mercury concentrations were expressed as the number of times the ULN. Then, inter- and intra-individual comparisons of exposure levels and body burden of mercury could be calculated more easily, particularly as three different units of measurement were reported for urine mercury concentrations. If the outcome data were incomplete or poorly described, clinical characteristics at presentation were included for analysis.
A comparative study of edetate calcium disodium and dimercaptosuccinic acid in the treatment of lead poisoning in adults
Published in Clinical Toxicology, 2018
Kirushanthi Sakthithasan, Pierre Lévy, Joël Poupon, Robert Garnier
DMSA allows outpatient treatment of lead poisoning and could constitute an alternative to CaNa2EDTA. However, prevention is the mainstay of treatment and the most effective measure consists of removal of the lead risk from the workplace. Working conditions of poisoned workers should be investigated and improved.