Arnold Justin, Morgan Brent
Department of Emergency Medicine, Emory University, 531 Asbury Circle, Annex Building Suite N340, Atlanta, GA, 30322, USA.
Georgia Poison Center, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA.
J Med Toxicol. 2015 Dec;11(4):464-7. doi: 10.1007/s13181-015-0493-9.
Lead encephalopathy is a severe manifestation of lead poisoning that can present with altered mental status and seizures and has been associated with illicit moonshine consumption. Lead encephalopathy has traditionally been treated using dimercaprol (British anti-Lewisite, BAL) and calcium disodium ethylenediaminetetraacetic acid (CaNa2EDTA).
We describe a patient with lead encephalopathy related to lead-contaminated moonshine consumption, who was treated using dimercaptosuccinic acid (DMSA) due to a national shortage of CaNa2EDTA. A 66-year-old woman presented to a hospital with headache, irritability, and altered mental status. On hospital day 16, she was found to have a whole blood lead concentration of 148.2 μg/dL and a 24-h urine lead concentration of 232 μg/day. Due to a national shortage of CaNa2EDTA, the patient was given one dose of BAL and then started on DMSA via nasogastric tube. She dramatically improved over 4 days and was subsequently transitioned to oral DMSA and outpatient treatment. One day prior to discharge, her whole blood lead concentration was 47.2 μg/dL and her mental status was normal. DMSA was used in lieu of CaNa2EDTA to treat the patient with lead encephalopathy. The patient subsequently experienced clinical improvement and declining whole blood level concentrations.
Further prospective studies are needed to compare the efficacy of DMSA versus CaNa2EDTA in patients with lead encephalopathy.
铅中毒性脑病是铅中毒的一种严重表现，可出现精神状态改变和癫痫发作，且与饮用非法私酿酒有关。传统上，铅中毒性脑病采用二巯丙醇（英国抗路易氏剂，BAL）和乙二胺四乙酸二钠钙（CaNa2EDTA）进行治疗。
我们描述了一名因饮用受铅污染的私酿酒而患铅中毒性脑病的患者，由于全国范围内CaNa2EDTA短缺，该患者使用二巯基丁二酸（DMSA）进行治疗。一名66岁女性因头痛、易怒和精神状态改变入院。在住院第16天，发现她的全血铅浓度为148.2μg/dL，24小时尿铅浓度为232μg/天。由于全国范围内CaNa2EDTA短缺，该患者先接受了一剂BAL治疗，然后通过鼻胃管开始使用DMSA治疗。她在4天内病情显著改善，随后转为口服DMSA并接受门诊治疗。出院前一天，她的全血铅浓度为47.2μg/dL，精神状态正常。使用DMSA替代CaNa2EDTA治疗铅中毒性脑病患者。该患者随后临床症状改善，全血铅水平浓度下降。
需要进一步进行前瞻性研究，以比较DMSA与CaNa2EDTA在铅中毒性脑病患者中的疗效。
