Dimercaptosuccinic acid (succimer; DMSA) in inorganic lead poisoning

Bradberry, Sally; Vale, Allister

doi:10.1080/15563650903174828

Cited by 87 publications

(64 citation statements)

References 74 publications

(119 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…DMSA is a stable water-soluble derivative of dimercaprol (BAL) that chelates lead, iron, mercury, zinc, nickel, arsenic, and cadmium [8]. In contrast with CaNa 2 EDTA, DMSA does not cross the bloodbrain barrier and thus removal of lead from the CNS likely occurs due to the development of a concentration gradient of lead between the CNS and blood [8]. Despite these differences in routes of administration and ability to penetrate the bloodbrain barrier, there are several case reports that appear to demonstrate the efficacy of DMSA in reducing whole blood lead concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…Thurtle et al reported on the treatment of 1307 lead poisoned Nigerian children younger than 5 years of age with venous blood lead concentrations >45 μg/dL [8]. Thirty-six percent of the children had venous blood lead concentrations >80 μg/dL while 6 % of the cohort had venous blood lead concentrations >120 μg/dL at the initiation of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Management of Lead Encephalopathy with DMSA After Exposure to Lead-Contaminated Moonshine

Arnold

Morgan

2015

J. Med. Toxicol.

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Background Lead encephalopathy is a severe manifestation of lead poisoning that can present with altered mental status and seizures and has been associated with illicit moonshine consumption. Lead encephalopathy has traditionally been treated using dimercaprol (British antiLewisite, BAL) and calcium disodium ethylenediaminetetraacetic acid (CaNa 2 EDTA). Case Report We describe a patient with lead encephalopathy related to lead-contaminated moonshine consumption, who was treated using dimercaptosuccinic acid (DMSA) due to a national shortage of CaNa 2 EDTA. A 66-year-old woman presented to a hospital with headache, irritability, and altered mental status. On hospital day 16, she was found to have a whole blood lead concentration of 148.2 μg/dL and a 24-h urine lead concentration of 232 μg/day. Due to a national shortage of CaNa 2 EDTA, the patient was given one dose of BAL and then started on DMSA via nasogastric tube. She dramatically improved over 4 days and was subsequently transitioned to oral DMSA and outpatient treatment. One day prior to discharge, her whole blood lead concentration was 47.2 μg/dL and her mental status was normal. DMSA was used in lieu of CaNa 2 EDTA to treat the patient with lead encephalopathy. The patient subsequently experienced clinical improvement and declining whole blood level concentrations. Conclusion Further prospective studies are needed to compare the efficacy of DMSA versus CaNa 2 EDTA in patients with lead encephalopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Lead Encephalopathy with DMSA After Exposure to Lead-Contaminated Moonshine

Arnold

Morgan

2015

J. Med. Toxicol.

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“…Chelation with dimercaptosuccinic acid (succimer) or ethylenediaminetetraacetic acid (EDTA) is indicated for more severe cases as in our patient. [2][3][4] The number of adults with elevated blood lead levels (>25 mcg/dl) has decreased over the past decade, with an incidence of 6 per 100,000 in 2009. Over 95 % of lead exposures are occupational, especially in industries such as battery manufacturing, metal mining, and painting.…”

Section: Discussionmentioning

confidence: 99%

Buyers Beware: Lead Poisoning due to Ayurvedic Medicine

2012

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A 29-year-old man, who recently emigrated from India, presented with a 2-week history of abdominal pain, as well as nausea, constipation, and fatigue. He underwent removal of a parathyroid adenoma 6 weeks prior to admission and received a locally made Indian traditional medicine (Ayurveda) for pain control; however, this information was not initially available. He was instructed to take approximately 15 g/day. Initial evaluation revealed a normocytic anemia, but other workup including imaging and endoscopy was unrevealing. Given his recent use of Ayurvedic medicines, we tested for lead poisoning and found a blood lead level of 72 mcg/dl. We sent his medicine for analysis and found it had a high lead concentration of 36,000 mcg/g, which is over 25,000 times the maximum daily dose. He improved with cessation of the medicine and treatment with succimer. Lead poisoning can present with a variety of nonspecific signs and symptoms, including abdominal pain and anemia. Ayurvedic medicines, as well as traditional medicines from other cultures, may be a source of lead or other heavy metals. It is essential for physicians to be aware of adverse effects of Ayurvedic medicines as they are easily available and increasing in popularity.

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“…Physicians should be aware of such possibility, especially when these drugs are readily available and often contain lead. We used d-Pencillamine to treat our patient as succimer (DMSA), which is the drug of choice, [13] is not easily available in India and is expensive (US$ 800/month). Our patient successfully responded, like in a few other reported cases.…”

Section: Discussionmentioning

confidence: 99%