Gordon R A, Roberts G, Amin Z, Williams R H, Paloucek F P
Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago 60612, USA.
Arch Pediatr Adolesc Med. 1998 Nov;152(11):1100-4. doi: 10.1001/archpedi.152.11.1100.
To report a case of a 3-year-old child with an extraordinarily massive lead concentration, 26.4 micromol/L (550 microg/dL), following environmental exposure to lead paint in the home.
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.
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.
报告一例3岁儿童因在家中接触含铅油漆而导致血铅浓度异常高，达26.4微摩尔/升（550微克/分升）的病例。
在对该患儿进行治疗及撰写本文的过程中，对有关铅中毒性脑病治疗的相关文献进行了回顾。据我们所知，朱利安·奇泽姆1968年撰写的具有里程碑意义的文章是近期唯一一篇报道过类似高血铅浓度水平的文章。然而，该病例是首例使用三种螯合剂治疗铅中毒性脑病的病例。我们还回顾了有关全肠道灌洗在重金属中毒治疗中应用的文献。
在该病例中，采用全肠道灌洗进行积极的肠道去污，并使用二巯丙醇、乙二胺四乙酸和口服二巯基丁二酸进行三联螯合疗法，患儿耐受性良好，且似乎能有效快速降低患儿体内的铅含量。在仅使用口服二巯基丁二酸治疗期间患儿血铅浓度仍有所上升，因此有必要进一步使用乙二胺四乙酸进行螯合治疗。有必要进行进一步评估，以确定三联螯合疗法是否是治疗重度铅中毒的合适方法，以及在重金属中毒时是否应考虑采用全肠道灌洗。
