Effects of Calcium Disodium Versenate (CaNa2EDTA) Chelation in Moderate Childhood Lead Posioning

PEDIATRICS ◽  
1993 ◽  
Vol 92 (2) ◽  
pp. 265-271
Author(s):  
Morri E. Markowitz ◽  
Polly E. Bijur ◽  
Holly Ruff ◽  
John F. Rosen
Keyword(s):  
Lead Poisoning ◽  
Chelation Therapy ◽  
Controlled Trial ◽  
Lead Level ◽  
Chelating Agent ◽  
Blood Lead ◽  
Erythrocyte Protoporphyrin ◽  
Bone Lead ◽  
Sustained Reduction ◽  
The Relationship

Background. For children with asymptomatic moderate lead poisoning (Blood lead level [BPb] 25 to 55 µg/dL [1.21 to 2.66 µmol/L]), treatment with the chelating agent calcium disodium versenate (CaNa2EDTA) is recommended for all those children with a BPb level >45 µg/dL (2.17 µmol/L) and for those with a BPb level of 25 to 44 µg/dL (1.21 to 2.13 µmol/L) who also have a positive lead mobilization test. However, controlled studies demonstrating its efficacy at inducing a sustained reduction in BPb level or lead-related toxicity have not been performed in children with moderate lead poisoning. This study assesses the relationship between CaNa2EDTA chelation and measures of lead burden and toxicity in children with moderate lead poisoning. Methods. Two hundred one children with moderate lead poisoning were enrolled. Sequential changes in BPb concentrations, bone lead level as measured by Lα-x-ray fluorescence, and lead-induced toxicity as assessed by erythrocyte protoporphyrin levels were determined over a 7-week period. From this group, children with a positive lead mobilization test received CaNa2EDTA chelation therapy. Results. Children with positive lead mobilization tests had on average higher initial BPb, bone lead, and erythrocyte protoporphyrin concentrations. The chelated children decreased approximately 4.7 µg/dL (0.23 µmol/L), 41 corrected net counts, and 24 µg/dL (0.46 µmol/L) more than the unchelated children on BPb, bone lead, and erythrocyte protoporphyrin values, respectively. However, children with higher initial levels decreased the most, whereas children with lower initial levels showed the least decline, with or without treatment. When the initial values on the measures were controlled analytically, or when subgroups matched on initial levels were compared, there were no significant differences between the chelated and unchelated children. Conclusions. The apparent effectiveness of CaNa2EDTA at reducing lead burden and toxicity is no longer observed when the pretreatment levels are considered. The findings suggest that sufficient doubt about CaNa2EDTA efficacy now exists to warrant a randomized controlled trial of chelation therapy in moderately lead-poisoned children. However, until such studies are performed, it would be premature to withhold chelation treatment on the basis of this study alone.

Setting the Optimal Erythrocyte Protoporphyrin Screening Decision Threshold for Lead Poisoning: A Decision Analytic Approach

PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 121-131
Author(s):  
Michael R. DeBaun ◽  
Harold C. Sox
Keyword(s):  
Lead Poisoning ◽  
Characteristic Curve ◽  
Lead Level ◽  
Blood Lead ◽  
Receiver Operator Characteristic Curve ◽  
Receiver Operator Characteristic ◽  
Decision Threshold ◽  
Erythrocyte Protoporphyrin ◽  
Positive Rate ◽  
The Relationship

Erythrocyte protoporphyrin (EP) was introduced in the 1970s as an inexpensive screening test for lead poisoning. As greater knowledge of lead poisoning has accumulated, the recommended EP level at which further evaluation for lead poisoning should be initiated has been lowered from ≥50 µg/dL to ≥35 µg/dL. The purpose of this study was to evaluate the utility of this EP threshold. A receiver operator characteristic curve was constructed to assess the relationship between the true-positive rate and false-positive rate of EP at various decision thresholds. The receiver operator characteristic curve was constructed with data from the second National Health and Nutrition Examination Survey from 1976 to 1980, which included 2673 children 6 years of age or younger who had both blood lead and EP level determinations. Decision analysis was then used to determine the optimal EP decision threshold for detecting a blood lead level ≥25 µg/dL. The receiver operator characteristic curve demonstrated that EP is a poor predictor of a blood lead level ≥25 µg/dL. At the currently recommended EP decision threshold of 35 µg/dL, the true-positive rates and false-positive rates of EP are 0.23 and 0.04, respectively. As a result of the inadequate performance of EP screening for lead poisoning, when the prevalence of lead poisoning is greater than 8%, there is no EP decision threshold that optimizes the relationship between the cost of screening normal children and the benefit of detecting lead-poisoned children. Erythrocyte protoporphyrin measurement is not sufficiently sensitive to be recommended uniformly as a screening test for lead poisoning.

scholarly journals Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting with Motor Neuropathy and Upper Limb Paresis: A case report

2019 ◽  
Vol 18 (4) ◽  
pp. 529 ◽  
Author(s):  
Seyed M. M. Mirzaei ◽  
Ayob Akbari ◽  
Omid Mehrpour ◽  
Nasim Zamani
Keyword(s):  
Nervous System ◽  
Case Report ◽  
Lead Poisoning ◽  
Chelation Therapy ◽  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Motor Neuropathy ◽  
Upper Limbs ◽  
Gastrointestinal Complications

Opium users may present with central or peripheral nervous system-related symptoms, gastrointestinal complications and anaemia; in such cases, lead poisoning should be suspected and chelation therapy initiated as soon as possible. We report a 64-year-old male patient with a 20-year history of opium addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with severe motor neuropathy and paresis in both upper limbs. His primary symptoms were generalised weakness, abdominal and bone pain, constipation and lower limb paraesthesia that had started several months prior. In addition, he reported severe progressive bilateral paresis of the upper limbs of one month’s duration. A diagnosis of lead poisoning was confirmed by a blood lead level of 140 μg/dL. The patient underwent chelation therapy after which he improved significantly. At a one-year follow-up visit, he was neurologically intact and symptom-free.Keywords: Opium Dependence; Lead Poisoning; Lead-Induced Nervous System Diseases; Paresthesia; Case Report; Iran.

Management of Childhood Lead Poisoning: A Survey

PEDIATRICS ◽  
1992 ◽  
Vol 89 (4) ◽  
pp. 614-618
Author(s):  
Deborah E. Glotzer ◽  
Howard Bauchner
Keyword(s):  
Lead Poisoning ◽  
Chelation Therapy ◽  
Provocation Test ◽  
Chelating Agent ◽  
Blood Lead ◽  
Blood Lead Levels ◽  
Childhood Lead Poisoning ◽  
Lead Levels ◽  
Provocation Testing ◽  
Orally Active

Published recommendations (1985) for the management of childhood lead poisoning suggest the use of ethylenediaminetetraacetic acid (EDTA)provocation testing and chelation as the mainstay of treatment for blood lead levels between 25 and 55 μg/dL. Since 1985 evidence has accumulated indicating that (1) levels of blood lead less than 25 μg/dL are detrimental to cognitive development, (2) EDTA provocation testing may result in potentially harmful shifts in the body lead burden, and (3) oral agents such as penicillamine and 2,3-dimercaptosuccinic acid are effective in reducing elevated lead levels. To determine how this evidence impacts on the management of childhood lead poisoning, the authors surveyed the lead poisoning clinics of pediatric departments in the cities estimated by the United States Public Health Service to have the largest number of children affected by lead poisoning. Thirty (70%) of 43 surveys were completed. Respondents indicated that the lowest blood lead level for which they would use a chelating agent to reduce the lead burden was as follows: 50 μg/dL (3%), 45 μg/dL (3%), 40μg/dL (13%) 35 μg/dL (3%), 30 μg/dL (27%), 25 μg/dL (47%) and 20μg/dL (3%). For all blood lead levels from 20 through 55 μg/dL, EDTA was the most frequently recommended chelating agent (chelation and provocation testing). Fifteen percent of responding lead clinics do not use the provocation test under any circumstances. For a child with a negative EDTA provocation test, the percentage of respondents recommending the use of any chelation therapy ranged from 16% for blood lead levels of 25 through 29μg/dL to 66% for levels of 50 through 55 μg/dL. Orally active chelating agents are used by fewer than one third of the responding lead clinics and were selected as the chelating agent of choice at all blood lead levels from 25 through 55 μg/dL by at least one respondent. The results of this survey indicate the following: (1) There is a wide range of blood lead levels for which chelation therapy is recommended. (2) The majority of children with elevated lead burdens are managed using EDTA. (3) The EDTA provocation test continues to be widely used. (4) The majority of children with blood lead levels of 25 through 44 μg/dL with negative provocation tests do not receive chelation therapy. (5) Orally active chelating agents are used in the minority of lead clinics. (6) No common approach for the treatment of lead toxicity appears to exist. (7) In the majority of pediatric centers, current management of blood lead elevation does not appear to reflect new information regarding the effects and treatment of lead poisoning.

scholarly journals A CASE REPORT ON CHRONIC LEAD POISONING FROM OCCUPATIONAL EXPOSURE

2017 ◽  
Vol 10 (6) ◽  
pp. 1
Author(s):  
Dhivya K ◽  
Nazma M ◽  
Divya Sree P ◽  
Lakshmi Prasanna S
Keyword(s):  
Lead Poisoning ◽  
Chelation Therapy ◽  
Lead Level ◽  
Age Groups ◽  
Blood Lead ◽  
Toxic Heavy Metals ◽  
The World ◽  
Education And Awareness ◽  
Lead Hazards ◽  
Upper Abdomen

The hazard to public health from lead continues to be a matter of concern. It is one of the most serious environmental poisons among the toxic heavy metals all over the world. Lead poisoning is seen in all age groups, especially in adults working in lead-based industries. We report the case of a 28-year-old man working in an unorganized lead-based manufacturing unit admitted with the complaints of giddiness, excessive tiredness, pain in the upper abdomen, decreased appetite, excessive body pains, increased sweating, and oliguria. Investigations carried out during the admission showed hemoglobin levels of 8.5 g/dl and blood lead level (BLL) of 115 μg/dl. The patient was subjected to chelation therapy. After repeated course of chelation therapy, he has shown the signs of improvement. The paucity of a safe workplace and awareness among workers results in high BLLs. Therefore, education and awareness related to lead hazards is considered necessary.

Lead Poisoning: Twenty Years After

PEDIATRICS ◽  
1993 ◽  
Vol 92 (3) ◽  
pp. 505-505
Author(s):  
HENRIETTA SACHS ◽  
DONALD I. MOEL
Keyword(s):  
Disease Control ◽  
Lead Poisoning ◽  
Blood Lead Level ◽  
Scientific Evidence ◽  
Lead Level ◽  
Blood Lead ◽  
Neurobehavioral Development ◽  
Long Term Follow Up

To the Editor.— In October 1991, the Centers for Disease Control decreased the blood lead level PbB) from 25 to 10 µg/dL and designated it as abnormal because of "overwhelming and compelling scientific evidence"1 that 10 µg/dL is associated with adverse neurobehavioral development. We have evidence to the contrary, obtained in a long-term follow-up of severely lead-poisoned children whom we treated before 1972 for PbBs between 80 and 470 µg/dL (mean, 150.3 ± 77.1 µg/dL); their mean age was 28 months.

Too Much Lead, Too Little Iron

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 395-395
Author(s):  
MARGARET CLARK
Keyword(s):  
Public Health ◽  
Iron Deficiency ◽  
Lead Poisoning ◽  
Predictive Value ◽  
Blood Lead ◽  
Blood Lead Levels ◽  
The Public ◽  
Erythrocyte Protoporphyrin ◽  
Lead Levels

In Reply.— We appreciate the work of Carraccio et al which confirms our findings that the anemia found in children with lead poisoning results from coexistent iron deficiency. The discrepancy between the two studies concerning the predictive value of blood lead in elevations of erythrocyte protoporphyrin bears further exploration. What is striking, however, is that in both series more than 50% of the variability in erythrocyte protoporphyrin remains unexplained. Now the public health focus is on detecting children with low blood lead levels—before even subtle CNS damage has occurred.

scholarly journals Against lead poisoning: effectiveness of housing first and counselling in the home

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Laporte ◽  
H Barberin de Barberini ◽  
E Jouve ◽  
K Hadji ◽  
S Gentile
Keyword(s):  
Lead Poisoning ◽  
Lead Exposure ◽  
Blood Lead Level ◽  
Lead Level ◽  
Blood Lead ◽  
Housing First ◽  
Blood Lead Levels ◽  
Stable Housing ◽  
Lead Levels

Abstract Background Removing lead sources is the main measure against child lead poisoning. Medical treatment is ineffective for most mild cases and particularly against long-term complications in neurological development. However, the effectiveness of interventions to eliminate sources of lead exposure has not been fully established, mainly because of the diversity of situations. The objective of this study was to determine the influence of several interventions (housing counselling, rehabilitation and relocation) on blood lead levels in two situations (stable unhealthy housing with old flaked lead paints, slums with family recycling practices by incineration). Methodology A historical cohort of lead poisoning in children has been established in Marseille, France. Medical follow-up followed national guidelines. Environmental interventions followed legal procedures, where available. In slums, counselling was adapted to the exposure. A generalized mixed model was developed to study the kinetics of blood lead levels after the interventions. Results 151 children were included; age = 5.4 (SD = 7.8) years; 85 (56%) lived in stable unhealthy housing, others lived in slums. Medical follow-up included 492 blood lead levels. For children living in stable unhealthy housing, blood lead level decrease was significantly associated with every intervention: housing counselling, rehabilitation and relocation (respectively p < 0.005; p < 0.05 and p < 0.005). For children living in slums, blood lead level decrease was only associated with relocation in a stable housing (p < 0.005). Conclusions Several interventions are effective to decrease blood lead levels in unhealthy housing. In slums, access to a stable housing first is a prerequisite for any intervention against child lead poisoning, even when related to family practices. Key messages In stable unhealthy housing, several interventions against lead exposure can be effective to raise a strategy. But, environmental health and access to housing first needs to be addressed for their implementation.

scholarly journals Lead Exposure and Intellectual Function: Findings from Primary School Children in Bangladesh

2012 ◽  
Vol 11 (4) ◽  
pp. 292-297
Author(s):  
Mahbuba Haque ◽  
M H Faruquee ◽  
Suman Lahiry ◽  
Saira Tasmin ◽  
Rabeya Yasmin ◽  
...  
Keyword(s):  
Primary School ◽  
Lead Poisoning ◽  
School Children ◽  
Blood Lead Level ◽  
Lead Level ◽  
Medical Science ◽  
Blood Lead ◽  
Primary School Children ◽  
Background Information ◽  
The Impact

Backgrounds: About 120 million people around the world are overexposed to lead which is neurotoxic and 99 percent of the most severely affected children are in the developing world including Bangladesh. Methods and Materials: The present cross-sectional ecological study was carried out to explore the impact of lead poisoning on the intelligence level among 84 primary school children of a school of Bangladesh, aged between 8 and 14 years from September 2010 through January 2011. The research instrument was an interviewer questionnaire, questionnaire for IQ test and assessment of blood lead level (inductively-coupled plasma mass spectrometry with collision/reaction cells) of the study subjects after obtaining permission from their parents and the school authority. Results: Data were cross-checked and frequency distribution and association using chi-square test was accomplished. Background information depicted majority (69.1%) of the children aged10-11 years (mean = 10.25 ±1.177 yrs), female (51.2%), parents having primary level of education or below (73.8% in case of father and 77.4% in mother) and from lower socioeconomics (78.6% earned BDT 10,000 or below per month). Among all, majority (56%) were found to be moron, 27.4% in borderline, while 8.3% were imbecile with the same proportion with normal level. By their blood lead level. Majority (70.2%) had blood lead level up to 10 microgram/dl and the rest (29.8%) had more than 10 microgram/dl. Though no statistically significant association was found between IQ level of the children and their blood lead level (p>0.05), the health problems found among the respondents as abdominal pain (53.57%), impatience (14.29%), nausea (10.71%) and all other problems (loss of concentration to study, ear problem, anorexia and loss of weight) amounting for 21.43% are suggestive of chronic lead poisoning. Conclusion:Further studies in large scale with larger samples including comparative studies of inter-industrial areas have been strongly recommended. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12599 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12  

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