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

Abstract

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.

In vitro activity of EDTA and TOL-463 against Neisseria gonorrhoeae

“…Development of TOL-463 as a topical treatment for vaginitis is safe and effective (Marrazzo et al, 2018), but this formulation limits its clinical utility against urethral and rectal gonorrhea infections. EDTA, the active component of TOL-463, is FDA-approved to treat lead poisoning and lead encephalopathy through intravenous administration (Arnold and Morgan, 2015;Ogawa et al, 2008), suggesting that EDTA could potentially be delivered systemically to treat extragenital and urethral gonococcal infections. However, bioavailability studies at these anatomical sites are needed.…”

Ayurvedic plumbism

“…9 However, there are significant drawbacks to IV chelation, including hospital admission and side-effects, such as nephrotoxicity, parathaesia and myalgias (in up to 50% of cases with Dimercaprol). 10,11 Our case demonstrates the efficacy and safety of using oral chelation agents in patients with very high lead levels. 10,11 Our case demonstrates the efficacy and safety of using oral chelation agents in patients with very high lead levels.…”

“…9 There is growing evidence that in cases of severe lead toxicity, oral agents can be used. 10,11 Our case demonstrates the efficacy and safety of using oral chelation agents in patients with very high lead levels.…”

Selective anisotropic growth of Bi2S3 nanoparticles with adjustable optical properties

“…[37][38][39][40][41] Its research has been primarily focused on plasmonic and magnetic NPs in the fields of medical imaging, [37][38][39][40]42 magnetic hyperthermia, and drug delivery, 43 and as an efficient removal agent of mercury, arsenic, and lead. 44,45 However, its use in elongated Bi 2 S 3 NPs has to our knowledge been unexplored.…”