A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage
Introduction For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa 2 EDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an a...
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| Veröffentlicht in: | Journal of medical toxicology 2024-01, Vol.20 (1), p.49-53 |
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| creator | Idowu, Damilola Gray, Zachary Stanton, Matthew Rushton, William Gummin, David |
| description | Introduction
For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa
2
EDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNa
2
EDTA was unavailable.
Case Report
A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNa
2
EDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits.
Discussion
The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care. |
| doi_str_mv | 10.1007/s13181-023-00970-2 |
| format | Article |
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For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa
2
EDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNa
2
EDTA was unavailable.
Case Report
A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNa
2
EDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits.
Discussion
The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care.</description><identifier>ISSN: 1556-9039</identifier><identifier>ISSN: 1937-6995</identifier><identifier>EISSN: 1937-6995</identifier><identifier>DOI: 10.1007/s13181-023-00970-2</identifier><identifier>PMID: 37843802</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Biomedical and Life Sciences ; Biomedicine ; Blood ; Blood levels ; Brain Diseases - drug therapy ; Cardiac arrest ; Case Report ; Chelating agents ; Chelating Agents - therapeutic use ; Chelation ; Child ; Child, Preschool ; Cognitive ability ; Dimercaprol ; Dimercaptosuccinic acid ; Edetic acid ; Edetic Acid - therapeutic use ; Emergency medical care ; Emergency medical services ; Emergency vehicles ; Encephalopathy ; Heart ; Heart Arrest - drug therapy ; Humans ; Lead ; Lead Poisoning ; Male ; Patients ; Pediatrics ; Pharmacology/Toxicology ; Seizures ; Shortages ; Succimer - therapeutic use</subject><ispartof>Journal of medical toxicology, 2024-01, Vol.20 (1), p.49-53</ispartof><rights>American College of Medical Toxicology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. American College of Medical Toxicology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c382t-1c368dd0ba6d2568fc2b3aaef943f18c1e0bacf2f07a59990a1a280ac0d68d823</cites><orcidid>0009-0000-5266-2864</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10774239/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10774239/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,41467,42536,51298,53770,53772</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37843802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Idowu, Damilola</creatorcontrib><creatorcontrib>Gray, Zachary</creatorcontrib><creatorcontrib>Stanton, Matthew</creatorcontrib><creatorcontrib>Rushton, William</creatorcontrib><creatorcontrib>Gummin, David</creatorcontrib><title>A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage</title><title>Journal of medical toxicology</title><addtitle>J. Med. Toxicol</addtitle><addtitle>J Med Toxicol</addtitle><description>Introduction
For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa
2
EDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNa
2
EDTA was unavailable.
Case Report
A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNa
2
EDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits.
Discussion
The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care.</description><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Blood</subject><subject>Blood levels</subject><subject>Brain Diseases - drug therapy</subject><subject>Cardiac arrest</subject><subject>Case Report</subject><subject>Chelating agents</subject><subject>Chelating Agents - therapeutic use</subject><subject>Chelation</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cognitive ability</subject><subject>Dimercaprol</subject><subject>Dimercaptosuccinic acid</subject><subject>Edetic acid</subject><subject>Edetic Acid - therapeutic use</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency vehicles</subject><subject>Encephalopathy</subject><subject>Heart</subject><subject>Heart Arrest - drug therapy</subject><subject>Humans</subject><subject>Lead</subject><subject>Lead Poisoning</subject><subject>Male</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pharmacology/Toxicology</subject><subject>Seizures</subject><subject>Shortages</subject><subject>Succimer - therapeutic use</subject><issn>1556-9039</issn><issn>1937-6995</issn><issn>1937-6995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU1v1DAQhq0K1C_4Az1UlrhwCYztfNinarW0gLSIQ-GGZM06k02qbJzaSVH_PV62FNoDJ9t633lmxi9jZwLeCYDqfRRKaJGBVBmAqSCTB-xYGFVlpTHFi3QvijIzoMwRO4nxBiC9ZX7IjlSlc6VBHrMfC77ESNw3_JruKBBfEdb8cnA0ttj7Eaf2nv_spjb5Qt2h44sQKE78Cw64oZp_mEM3bDjyZUs9Tp0f-HXrw5TEV-xlg32k1w_nKft-dflt-Slbff34eblYZU5pOWXCqVLXNayxrGVR6sbJtUKkxuSqEdoJSpJrZAMVFsYYQIFSAzqoU52W6pRd7LnjvN5S7WiYAvZ2DN0Ww7312NmnytC1duPvrICqyqUyifD2gRD87ZzWs9suOup7HMjP0UpdaRC6hF2zN8-sN34OQ9rPSiNEmUthdHLJvcsFH2Og5nEaAXaXnt2nZxPR_k7P7tDn_-7xWPInrmRQe0Mcd59O4W_v_2B_AS-GpVc</recordid><startdate>20240101</startdate><enddate>20240101</enddate><creator>Idowu, Damilola</creator><creator>Gray, Zachary</creator><creator>Stanton, Matthew</creator><creator>Rushton, William</creator><creator>Gummin, David</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0009-0000-5266-2864</orcidid></search><sort><creationdate>20240101</creationdate><title>A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage</title><author>Idowu, Damilola ; Gray, Zachary ; Stanton, Matthew ; Rushton, William ; Gummin, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382t-1c368dd0ba6d2568fc2b3aaef943f18c1e0bacf2f07a59990a1a280ac0d68d823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Blood</topic><topic>Blood levels</topic><topic>Brain Diseases - drug therapy</topic><topic>Cardiac arrest</topic><topic>Case Report</topic><topic>Chelating agents</topic><topic>Chelating Agents - therapeutic use</topic><topic>Chelation</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cognitive ability</topic><topic>Dimercaprol</topic><topic>Dimercaptosuccinic acid</topic><topic>Edetic acid</topic><topic>Edetic Acid - therapeutic use</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency vehicles</topic><topic>Encephalopathy</topic><topic>Heart</topic><topic>Heart Arrest - drug therapy</topic><topic>Humans</topic><topic>Lead</topic><topic>Lead Poisoning</topic><topic>Male</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pharmacology/Toxicology</topic><topic>Seizures</topic><topic>Shortages</topic><topic>Succimer - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Idowu, Damilola</creatorcontrib><creatorcontrib>Gray, Zachary</creatorcontrib><creatorcontrib>Stanton, Matthew</creatorcontrib><creatorcontrib>Rushton, William</creatorcontrib><creatorcontrib>Gummin, David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of medical toxicology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Idowu, Damilola</au><au>Gray, Zachary</au><au>Stanton, Matthew</au><au>Rushton, William</au><au>Gummin, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage</atitle><jtitle>Journal of medical toxicology</jtitle><stitle>J. Med. Toxicol</stitle><addtitle>J Med Toxicol</addtitle><date>2024-01-01</date><risdate>2024</risdate><volume>20</volume><issue>1</issue><spage>49</spage><epage>53</epage><pages>49-53</pages><issn>1556-9039</issn><issn>1937-6995</issn><eissn>1937-6995</eissn><abstract>Introduction
For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa
2
EDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNa
2
EDTA was unavailable.
Case Report
A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNa
2
EDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits.
Discussion
The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37843802</pmid><doi>10.1007/s13181-023-00970-2</doi><tpages>5</tpages><orcidid>https://orcid.org/0009-0000-5266-2864</orcidid></addata></record> |
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| ispartof | Journal of medical toxicology, 2024-01, Vol.20 (1), p.49-53 |
| issn | 1556-9039 1937-6995 1937-6995 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Biomedical and Life Sciences Biomedicine Blood Blood levels Brain Diseases - drug therapy Cardiac arrest Case Report Chelating agents Chelating Agents - therapeutic use Chelation Child Child, Preschool Cognitive ability Dimercaprol Dimercaptosuccinic acid Edetic acid Edetic Acid - therapeutic use Emergency medical care Emergency medical services Emergency vehicles Encephalopathy Heart Heart Arrest - drug therapy Humans Lead Lead Poisoning Male Patients Pediatrics Pharmacology/Toxicology Seizures Shortages Succimer - therapeutic use |
| title | A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage |
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