Chronic Lead Poisoning Treated with Dimercaptosuccinic Acid

Abstract

A 54-year-old male with chronic lead poisoning was treated with 2.3-dimercaptosuccinic acid (DMSA). A daily dosage of 30 mg/kg body weight for three days and 20 mg/kg for four days resulted in a decrease of the blood-lead concentration (B-Pb) from 3.7 to 0.7 mumol/l; the total amount of lead excreted in the urine during the first seven 24 hr periods was 75 mumol. After the treatment, B-Pb slowly increased to 3.3 mumol/l. A second treatment was then initiated and resulted in similar changes in B-Pb. However, during the third treatment, the patient developed a mucocutaneous vesicular flare; the eruptions faded after cessation of the chelation therapy, but could be provoked by DMSA doses of 10 mg/kg and above. Despite the small number of treatment courses, the patient showed obvious mental improvement and reported less headache and improved memory. Thus, DMSA is an efficient chelator that results in a rapid, though temporary decrease in B-Pb. Although oral treatment with this chelator may be supervised from the out-patient clinic, careful monitoring for potential side effects is recommended.

Role of vitamins in treatment of lead intoxication

“…The non-specificity of metal chelating agents and their adverse side effects, including depletion of endogenous essential elements, emphasize the need for an alter- nate to chelation therapy in metal intoxication [8,10,11]. The recent surge for nutritional modulation for prevention or amelioration of chemical toxicity supports this requirement and offers promise [19].…”

Diagnosis and Treatment of Metal Poisoning

“…They include gastrointestinal discomfort, skin reaction, mild neutropenia, and elevated liver enzymes. A strong musculocutaneous reaction was reported in one case of chronic lead poisoning (Grandjean et al, 1991) and hemolytic anemia was reported in a worker with occupational lead exposure (Gerr et al, 1994).…”

Diagnóstico e tratamento da intoxicação por chumbo em crianças e adultos

“…31 Outros dois trabalhos, relatando resultados de séries de casos de adultos tratados, mostraram boas eficácia e segurança no uso do DMSA em adultos e crianças. 32,33 Um ensaio clínico com 21 crianças com plumbemias variando entre 31 e 49 mcg/dL (todas com teste de mobilização de chumbo com dose padrão de EDTACaNa 2 positivo), e usando três subgrupos de doses diferentes contra grupo controle com tratamento tradicional com versenato de cálcio, mostrou uma redução significativa de chumbo no sangue durante o ciclo de tratamento, bem como o aumento da excreção urinária de chumbo e retorno dos níveis de ALA-U e ALA-D. O grupo utilizando DMSA não mostrou depleção de metais essenciais como zinco, magnésio, cobre, ferro e cálcio, ao contrário do grupo tratado com versenato. 34 Os níveis de plumbúria de 24 horas no grupo usando DMSA foram comparáveis aos do grupo usando EDTACaNa 2 (Figura 1).…”