The Effects of Succimer and Penicillamine on Acute Lead Poisoning Patients
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 11 No. 3 (2021),
18 July 2021
,
Page 33474
https://doi.org/10.32598/ijmtfm.v11i3.33474
Abstract
Background: Lead poisoning was on the rise in recent years. There exists a lack of easy access to some of the main chelator drugs in developing countries. Thus, this study aimed to explore the comparative effects of Succimer and D-Penicillamine on acute lead poisoning patients from 2013 to 2018.
Methods: This descriptive study was conducted in the Clinical Toxicology Department of Khorshid Hospital in Isfahan City, Iran. Adult patients with acute lead poisoning were included in the study. Patients in the 3 treatment groups of D-Penicillamine, D-Penicillamine with succimer, and succimer were compared concerning demographic characteristics as well as clinical and laboratory findings at admission time and two weeks later.
Results: In total, 163 patients were evaluated in this research. There was no significant difference between the treatment groups respecting improvement in clinical symptoms. The mean blood lead levels during hospitalization and two weeks after the treatment did not significantly differ between the three groups; however, there was a significant reduction in all study groups after two weeks of treatment (P<0.05). The mean white blood cell count was significantly lower only in the D-Penicillamine group two weeks after hospitalization (P<0.05). In the D-Penicillamine group, the mean platelet, hematocrit, and hemoglobin levels were significantly lower two weeks after hospitalization, although within the healthy range.
Conclusion: D-Penicillamine may be an acceptable chelator drug for treating patients with acute lead poisoning, especially in communities without access to drugs, like succimer.
- D-Penicillamine
- Succimer
- Poisoning
- Lead
- Treatment
How to Cite
References
Needleman H. Lead poisoning. Annu Rev Med. 2004; 55:209-22. [DOI:10.1146/annurev.med.55.091902.103653] [PMID]
Mostafazadeh B, Shadnia S, Tavakkoli MA, Vishteh HR. Evaluation of blood lead level in methamphetamine users in Tehran. Subst Abuse Treat Prev Policy. 2017; 12(1):2. [DOI:10.1186/s13011-017-0088-3] [PMID] [PMCID]
Ghane T, Zamani N, Hassanian-Moghaddam H, Beyrami A, Noroozi A. Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016-2017. Bull World Health Organ. 2018; 96(3):165-172. [DOI:10.2471/BLT.17.196287] [PMID] [PMCID]
Farhat AS, Parizadeh SM, Balali M, Khademi GR. Comparison of blood lead levels in 1-7 year old children with and without seizure. Neurosciences. 2005; 10(3):210-2 . [PMID]
Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. Goldfrank’s toxicologic emergencies. 11th ed. New York: McGraw-Hill Companies; 2019. https://www.amazon.com/Goldfranks-Toxicologic-Emergencies-Eleventh-Nelson/dp/1259859614
Zamani N, Mehrpour O, Hassanian-Moghaddam H, Jalali M, Amirabadizadeh A, Samie S, et al. A preliminary report on the largest ongoing outbreak of lead toxicity in Iran. Sci Rep. 2020 16; 10(1):11797. [DOI:10.1038/s41598-020-64859-8] [PMID] [PMCID]
Gagas DF. Characterization of contaminants on firefighter” s protective equipment a firefighter’s potential exposure to heavy metals during a structure fire [MSc. thesis]. United States: Eastern Kentucky University; 2015. https://encompass.eku.edu/etd/261/
Parada C. An analysis of inorganic lead surface contamination and employee cross-contamination in a precious metal assay laboratory [MSc. thesis]. United States: Montana Tech of the University of Montana; 2011. https://www.proquest.com/openview/5f2f82068ab42b4d516610c7fb7f7d3a/1?pq-origsite=gscholar&cbl=18750
Dapul H, Laraque D. Lead poisoning in children. Adv Pediatr. 2014; 61(1):313-33. [DOI:10.1016/j.yapd.2014.04.004] [PMID]
Chandran L, Cataldo R. Lead poisoning: Basics and new developments. Pediatr Rev. 2010; 31(10):399-405. [DOI:10.1542/pir.31-10-399] [PMID]
Kosnett MJ. Unanswered questions in metal chelation. J Toxicol Clin Toxicol. 1992; 30(4):529-47. [DOI:10.3109/15563659209017939] [PMID]
Henretig F. Lead poisoning prevention, not chelation (commentary). J Toxicol Clin Toxicol. 2001; 39(7):659-60. [DOI:10.1081/CLT-100108505] [PMID]
Bradberry S, Vale A. A comparison of sodium calcium edetate (edetate calcium disodium) and succimer (DMSA) in the treatment of inorganic lead poisoning. Clin Toxicol. 2009; 47(9):841-58. [DOI:10.3109/15563650903321064] [PMID]
Bradberry S, Vale A. Dimercaptosuccinic acid (succimer; DMSA) in inorganic lead poisoning. Clin Toxicol. 2009; 47(7):617-31. [DOI:10.1080/15563650903174828] [PMID]
Maiorino RM, Bruce DC, Aposhian HV. Determination and metabolism of dithiol chelating agents: VI. Isolation and identification of the mixed disulfides of meso-2, 3-dimercaptosuccinic acid with L-cysteine in human urine. Toxicol Appl Pharmacol. 1989; 97(2):338-49. [DOI:10.1016/0041-008X(89)90338-4]
Woolf AD, Goldman R, Bellinger DC. Update on the clinical management of childhood lead poisoning. Pediatr Clin North Am. 2007; 54(2):271-94. [DOI:10.1016/j.pcl.2007.01.008] [PMID]
American Academy of Pediatrics Committee on Environmental Health. lead exposure in children: Prevention, detection, and management. Pediatrics. 2006; 116(4):1036-46. [DOI:10.1542/peds.2005-1947] [PMID]
Kianoush S, Sadeghi M, Balali-Mood M. Recent advances in the clinical management of lead poisoning. Acta Med Iran. 2015; 53(6):327-36. [PMID]
Shannon MW, Townsend MK. Adverse effects of reduced-dose d-penicillamine in children with mild-to-moderate lead poisoning. Ann Pharmacother. 2000; 34(1):15-8. [DOI:10.1345/aph.19084] [PMID]
Paeezi M, Zamani N, Hassanian-Moghaddam H, Shadnia S, Zamani N, Chaleshi V, et al. Treatment of adult lead poisoning with D-penicillamine. Drug Metab Pers Ther. 2019; 34(2). [DOI:10.1515/dmpt-2019-0003] [PMID]
Farzaneh E, Habibzadeh A, Mehrpour O. Lead toxicity among oral opium addicts with abdominal pain: A case series of 17 cases. Indian J Forensic Med Toxicol. 2017; 11(2):22-5. [DOI:10.5958/0973-9130.2017.00057.3]
Shannon M, Graef J, Lovejoy FH Jr. Efficacy and toxicity of D-penicillamine in low level lead poisoning. J Pediatr. 1988; 112(5):799-804. [DOI:10.1016/S0022-3476(88)83212-8]
- Abstract Viewed: 343 times
- pdf Downloaded: 336 times