Division of Medical Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
Wisconsin Poison Center, PO Box 1997, Suite C660, Milwaukee, WI, 53226, USA.
J Med Toxicol. 2024 Jan;20(1):49-53. doi: 10.1007/s13181-023-00970-2. Epub 2023 Oct 16.
For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNaEDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNaEDTA was unavailable.
A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNaEDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits.
The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care.
多年来，美国的标准治疗方法一直是采用联合应用静脉内二巯丁二酸（BAL）和钙钠二巯丁二钠（CaNaEDTA）来治疗急性铅性脑病。我们报告了一例患有严重铅性脑病的儿科患者，由于 CaNaEDTA 无法获得，该患者在心脏骤停时接受了替代方案治疗。
一名 24 个月大的男性因新发性癫痫发作被救护车送往急诊部（ED），并发生持续心脏骤停。最初的血液铅浓度为 263 mcg/dl。由于全国性短缺，医院无法获得 CaNaEDTA。因此，患者接受了 12 天的 IM 肌肉内 BAL 螯合治疗和 28 天的二巯丁二酸（DMSA）螯合治疗。由于血液铅浓度反弹，他又接受了第二个为期 5 天的 BAL 疗程。心脏骤停 8 天后，他拔管；然而，尽管进行了持续治疗，随后在 2 个月后的后续随访中仍显示出持续的认知缺陷。
DMSA 和 BAL 的联合应用可迅速降低全血铅浓度。药物短缺继续对中毒患者的管理产生影响。本病例强调了螯合剂短缺如何使患者的护理复杂化。
