Document Detail

Aggressive approach in the treatment of acute lead encephalopathy with an extraordinarily high concentration of lead.
MedLine Citation:
PMID:  9811288     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To report a case of a 3-year-old child with an extraordinarily massive lead concentration, 26.4 micromol/L (550 microg/dL), following environmental exposure to lead paint in the home. LITERATURE REVIEW: The relevant literature concerning the treatment of lead encephalopathy was reviewed during the treatment of this child and preparation of the manuscript. To our knowledge, the landmark article written by Julian Chisolm in 1968 is the only recent article that reported similarly high levels of lead concentration. This case, however, is the first in which 3 chelating agents were used for the treatment of lead encephalopathy. We also reviewed the literature on the use of whole bowel irrigation in heavy metal intoxications. CONCLUSIONS: In this case, aggressive gut decontamination with whole bowel irrigation and triple chelation therapy with British anti-Lewisite, EDTA, and oral succimer was well tolerated and seemed effective for rapidly deleading the child. The extent to which her lead concentration increased while being treated with oral succimer alone necessitated further chelation with EDTA. Further evaluation is necessary to determine if triple chelation therapy is an appropriate method for severe lead intoxication, and if the use of whole bowel irrigation should be considered in heavy metal intoxication.
R A Gordon; G Roberts; Z Amin; R H Williams; F P Paloucek
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Archives of pediatrics & adolescent medicine     Volume:  152     ISSN:  1072-4710     ISO Abbreviation:  Arch Pediatr Adolesc Med     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1998-11-23     Completed Date:  1998-11-23     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9422751     Medline TA:  Arch Pediatr Adolesc Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1100-4     Citation Subset:  AIM; IM    
Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago 60612, USA.
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MeSH Terms
Brain Diseases / etiology*,  therapy
Child, Preschool
Dimercaprol / therapeutic use
Edetic Acid / therapeutic use
Environmental Exposure
Iron Chelating Agents / therapeutic use*
Lead / blood*
Lead Poisoning / blood,  therapy*
Paint / poisoning
Polyethylene Glycols / administration & dosage
Succimer / therapeutic use
Reg. No./Substance:
0/Iron Chelating Agents; 0/Polyethylene Glycols; 304-55-2/Succimer; 59-52-9/Dimercaprol; 60-00-4/Edetic Acid; 7439-92-1/Lead
Comment In:
Arch Pediatr Adolesc Med. 1999 Nov;153(11):1202   [PMID:  10555728 ]

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