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Related Experiment Videos

Chelation therapy in workers with lead exposure

S Royce1, J Rosenberg

  • 1Hazard Evaluation System and Information Service, California Department of Health Services, Berkeley 94704.

The Western Journal of Medicine
|April 1, 1993
PubMed
Summary

Physicians sometimes inappropriately prescribed chelation therapy for lead exposure, even for conditions like heart disease. Workplace lead surveillance programs were often inadequate, failing to protect workers from overexposure.

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Area of Science:

  • Occupational Health
  • Environmental Medicine
  • Toxicology

Background:

  • Occupational lead overexposure is a persistent public health issue.
  • Chelation therapy is a treatment for lead poisoning but requires careful consideration.
  • Physician prescribing practices for chelation therapy in lead exposure cases warrant evaluation.

Purpose of the Study:

  • To assess the appropriateness of chelation therapy prescription by physicians for occupational lead exposure.
  • To identify clinical settings and indications where chelation therapy is correctly or incorrectly used.
  • To evaluate the effectiveness of existing workplace lead medical surveillance programs.

Main Methods:

  • Case series identification of 7 workers with elevated blood lead levels.

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  • Review of physician phone calls and laboratory reports to California Department of Health Services.
  • Analysis of prescribing patterns and medical surveillance program adequacy.

    • Main Results:

    • Chelation therapy was indicated in 2 workers with severe symptoms and very high blood lead levels.
    • Inappropriate prescription occurred in workers with ongoing exposure (prophylaxis) and for atherosclerotic heart disease.
    • Personal physicians identified lead overexposure in 5 of 7 cases.
    • Mandated workplace lead medical surveillance was inadequate in all available cases.

    Conclusions:

    • Physician prescribing of chelation therapy for lead exposure requires careful clinical judgment to avoid inappropriate use.
    • Inadequate workplace surveillance programs contribute to occupational lead overexposure.
    • Improved medical surveillance and physician education are needed to ensure appropriate management of lead exposure.