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Peripheral Autonomic Neuropathies
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
The disease can be avoided by shunning contact with compounds containing mercury. Treatment is difficult and must be prolonged because the disease lasts from a few months up to a year. Management is mostly directed at relieving distress. Dimercaprol has been used with success, particularly when started early in the disorder. Ganglion-blocking agents have also been employed and are effective in abolishing the hyperhidrosis, the peripheral vasospasm and hypertension, but usually aggravate the photophobia. The mortality is higher in hospitalized children than in those kept at home because of the risk of cross-infection and the hospitalized children should be managed during their long illness by their parents.
Metals
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Anirudh J. Chintalapati, Frank A. Barile
Dimercaprol (2,3-dimercapto-1-propanol, British anti-lewisite, BAL; Figure 26.1) is an effective chelating agent for heavy metal poisoning (see Table 26.1).† BAL forms intracellular metallic ligands with its constituent sulfur atoms, rendering the complex unable to traverse cell membranes in preparation for renal elimination.
Melarsoprol
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Once PTRE occurs, the management consists of temporary cessation of melarsoprol, intravenous corticosteroids, anticonvulsants, intravenous hydration, antipyretics, and supportive measures, including general medical care and intensive support, if available (Kennedy, 2008). The use of mannitol and adrenaline has been reported, but their efficacy is unproven (Bouteille et al., 2003). Treatment with dimercaprol, a heavy metal chelating agent (and component of melarsoprol), has been shown to be of no benefit, and possibly to be harmful (Pepin et al., 1995). The antioxidants, anthocyanins from Kenyan purple tea, and coenzyme-Q10, have been studied in a mouse model and found to ameliorate reactive encephalopathy from melarsoprol with less neuroinflammation, microglial activation, and disruption of the brain parenchyma (Rashid et al., 2014).
Looking for the phoenix: the current research on radiation countermeasures
Published in International Journal of Radiation Biology, 2023
Vojtěch Chmil, Alžběta Filipová, Aleš Tichý
Chelating agents are a broad category of decorporating drugs. They are organic compounds that bind a metal atom by two or more coordinate covalent bonds. Trisodium calcium diethylenetriamine pentaacetate (Ca-DTPA) and trisodium zinc diethylenetriamine pentaacetate (Zn-DTPA) are representatives of FDA-approved chelators. They are able to chelate transuranic ions such as plutonium, americium or curium, which are removed by renal excretion of the formed chelates (Kazzi et al. 2012; FDA 2016, 2013). Other agents include deferoxamine (DFOA), which binds magnesium, iron, and chromium. A pair of thiol compounds dimercaprol, also known as British anti-lewisite (BAL) and dimercaptopropanesulphonate (DMPS), bind arsenic and other heavy metals. Some other drugs are under development for internalized radionuclides (IAEA 2018).
Fixed drug eruption due To 2,3-dimercapto-1-propanesulfonic acid (DMPS) treatment for mercury poisoning: a rare adverse effect
Published in Acta Clinica Belgica, 2019
Fatma Erden, Erol Rauf Agis, Meside Gunduzoz, Omer Hinc Yilmaz
Mercury is a highly toxic metal for human body and has a very wide range of uses in many fields such as agriculture, medicine, and industry. In order to prevent some diseases that may develop in various industrial branches associated with this toxic agent, employees are monitored in Ankara Occupational and Environmental Diseases Hospital in certain periods. During visits, appropiate antidotal therapy are given to patients with rising heavy metal levels. Throughout the world, Dimercaptosuccinic acid (DMSA), dimercaprol (BAL), and 2,3-dimercaptopropane-1-sulfonate (DMPS) are the agents used in chelation treatment in patients with high mercury levels [8,9]. Among the first choices for antidotal treatment in mercury exposure, DMPS (Dimaval®) is generally a drug with a low incidence of side effects and containing sulfon group. The most common unexpected effects are allergic skin reactions. It may cause variable skin lesions ranging from mild pruritus, erythematous lesion to erythema multiforme and Steven–Johnson syndrome [5]. FDE due to DMPS was not detected in our literature review. But, DMPS is a drug containing a sulfon group like dapsone and there are FDE cases associated with dapsone [10]. In this clinical presentation, it is possible to think this occured with a mechanism similar to dapsone [10].
Cyanide poisoning in Thailand before and after establishment of the National Antidote Project*
Published in Clinical Toxicology, 2018
Sahaphume Srisuma, Aimon Pradoo, Panee Rittilert, Sunun Wongvisavakorn, Achara Tongpoo, Charuwan Sriapha, Wannapa Krairojananan, Netnapis Suchonwanich, Sumana Khomvilai, Winai Wananukul
The antidotes are stocked and distributed in every region of the country based on urgency of the poisoning. A web-based program is used for real-time monitoring of the quantity of each antidote in each stockpile hospital. The same program is also used to locate the nearest stockpile hospital with available antidote to the requesting hospital. In clinical use, all antidotes are provided to Thai residents and foreign workers free of charge through the Thai Universal Coverage scheme [5,6]. Antidotes managed by the project include methylene blue, sodium nitrite, sodium thiosulfate, dimercaprol, succimer, calcium disodium edetate, DSFab, glucagon, and botulinum antitoxin [6,7]. To educate healthcare providers on poisoning and antidote use, there were annual countrywide educational programs by the Thai Society of Clinical Toxicology and the poison centers.