Controlled study of meso-2,3-dimercaptosuccinic acid for the management of childhood lead intoxication.

Abstract

We examined the efficacy and safety of meso-2,3-dimercaptosuccinic acid (DMSA) in children with markedly elevated blood lead (BPb) concentrations. Among 19 children with BPb concentrations of 50 to 69 micrograms/dl (2.41 to 3.33 mumol/L) who received a 5-day inpatient oral course of DMSA (1050 mg/m2 per day), the mean BPb concentration decreased by 61%; in four who received calcium disodium ethylenediaminetetraacetic acid (CaNa2EDTA) (1000 mg/m2 per day intravenously), it decreased by 45% (p less than 0.0007). Urinary lead excretion was comparable in both groups. Treatment with DMSA was more effective than treatment with CaNa2EDTA in restoring metabolic activity to the heme pathway and was well tolerated even among nine patients who received concomitant iron supplementation and two who had homozygous deficiency of glucose-6-phosphate dehydrogenase. On discharge, these 19 children received either no chelation therapy or DMSA, 350 or 700 mg/m2 per day for 14 days on an outpatient basis. After 14 days the mean BPb values for the no-chelation, low-DMSA, and high-DMSA groups were 73%, 66%, and 50% of the pretreatment values, respectively. We conclude that a 5-day oral course of DMSA is effective in the treatment of children with severe lead poisoning. In addition, on an outpatient basis the administration of DMSA, 700 mg/m2 per day, is capable of delaying the typical rebound in BPb values and should ultimately reduce the need for repeated hospitalizations.

• Authors: J H Graziano, N J Lolacono, T Moulton, M E Mitchell, V Slavkovich, C Zarate
• Journal: The Journal of pediatrics (J Pediatr) Vol. 120 Issue 1 Pg. 133-9 (Jan 1992) ISSN: 0022-3476 [Print] United States
• PMID: 1309865 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Chelating Agents
• Dimercaprol
• Lead
• Aminolevulinic Acid
• Edetic Acid
• Succimer
• Porphobilinogen Synthase
• Zinc
• Calcium

Topics

• Administration, Oral
• Ambulatory Care
• Aminolevulinic Acid (urine)
• Calcium (urine)
• Chelating Agents (administration & dosage, therapeutic use)
• Child
• Child, Preschool
• Dimercaprol (administration & dosage, therapeutic use)
• Edetic Acid (administration & dosage, therapeutic use)
• Erythrocytes (enzymology)
• Follow-Up Studies
• Humans
• Infant
• Injections, Intravenous
• Lead (blood, urine)
• Lead Poisoning (blood, drug therapy, urine)
• Porphobilinogen Synthase (blood)
• Safety
• Succimer (administration & dosage, therapeutic use)
• Zinc (urine)