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A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage

Damilola Idowu1,2, Zachary Gray3, Matthew Stanton4,5

  • 1Division of Medical Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA. dkedabol@gmail.com.

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology
|October 16, 2023
PubMed

Insights

A pediatric patient with severe lead encephalopathy and cardiac arrest was treated with dimercaptosuccinic acid (DMSA) and dimercaprol (BAL) due to a CaNa2EDTA shortage. This combination effectively lowered lead levels but cognitive deficits persisted.

Area of Science:

  • Toxicology
  • Pediatric Medicine
  • Emergency Medicine

Background:

  • The standard treatment for acute lead encephalopathy in the USA involves parenteral dimercaprol (BAL) and CaNa2EDTA.
  • A nationwide shortage of CaNa2EDTA necessitated an alternative treatment approach.

Observation:

  • A 24-month-old male presented with severe lead encephalopathy, seizures, and cardiac arrest (blood lead concentration 263 mcg/dl).
  • Treatment was initiated with BAL (12 days) and dimercaptosuccinic acid (DMSA) (28 days) due to unavailability of CaNa2EDTA.
  • A second course of BAL was required due to rebounding blood lead levels.

Findings:

  • The combined DMSA and BAL regimen effectively reduced whole blood lead concentrations.
  • Despite chelation therapy, the patient exhibited persistent cognitive deficits 2 months post-treatment.

Implications:

  • This case underscores the critical impact of drug shortages on managing poisoned patients.
  • Alternative chelation regimens may be effective in reducing lead levels but may not fully reverse neurological damage.
  • Ensuring availability of essential chelating agents is crucial for optimal patient outcomes in lead poisoning cases.
Abstract

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