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Aggressive Approach in the Treatment of Acute Lead Encephalopathy With an Extraordinarily High Concentration of Lead
Robert A. Gordon, PharmD;
Gerard Roberts, MD;
Zubair Amin, MD;
Robert H. Williams, PhD;
Frank P. Paloucek, PharmD, ABAT
Arch Pediatr Adolesc Med. 1998;152:1100-1104.
Objective To report a case of a 3-year-old child with an extraordinarily massive lead concentration, 26.4 µmol/L (550 µg/dL), following environmental exposure to lead paint in the home.
Literature Review The relevant literature concerning the treatment of lead encephalopathy was reviewed during the treatment of this child and preparation of the manuscript. To our knowledge, the landmark article written by Julian Chisolm in 1968 is the only recent article that reported similarly high levels of lead concentration. This case, however, is the first in which 3 chelating agents were used for the treatment of lead encephalopathy. We also reviewed the literature on the use of whole bowel irrigation in heavy metal intoxications.
Conclusions In this case, aggressive gut decontamination with whole bowel irrigation and triple chelation therapy with British anti-Lewisite, EDTA, and oral succimer was well tolerated and seemed effective for rapidly deleading the child. The extent to which her lead concentration increased while being treated with oral succimer alone necessitated further chelation with EDTA. Further evaluation is necessary to determine if triple chelation therapy is an appropriate method for severe lead intoxication, and if the use of whole bowel irrigation should be considered in heavy metal intoxication.
From the Department of Pharmacy Practice, College of Pharmacy (Drs Gordon and Paloucek), the Departments of Medicine (Dr Roberts and Paloucek) and Pediatrics (Drs Roberts and Amin), College of Medicine, University of Illinois, Chicago; and the Department of Pathology, University of Illinois Hospital and Clinics, Chicago (Dr Williams).
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