Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. e534-e536 (doi:10.1542/peds.2006-0858)
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EXPERIENCE AND REASON

Deaths Resulting From Hypocalcemia After Administration of Edetate Disodium: 2003-2005

Mary Jean Brown, ScD, RNa, Teresa Willisb, Bennet Omalu, MD, MPHc and Richard Leiker, MSd

a Lead Poisoning Prevention Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
b Blood Lead Surveillance Group, Texas Department of State Health Services, Austin, Texas
c Allegheny County Medical Examiner's Office, Pittsburgh, Pennsylvania
d Lead Poisoning Prevention Program, Oregon State Public Health, Portland, Oregon

From 2003 to 2005, deaths of 3 individuals as a result of cardiac arrest caused by hypocalcemia during chelation therapy were reported to the Centers for Disease Control and Prevention. Two were children, both of whom were treated with edetate disodium. At the time of this writing, the adult case was still under investigation. No previous cases of death resulting from hypocalcemia during chelation have been reported. From our experience and review of the literature, we suggest that health care providers who are unfamiliar with chelation consult an expert before undertaking treatment and that hospital formularies evaluate whether stocking edetate disodium is necessary, given the risk for hypocalcemia and the availability of less toxic alternatives.

Key Words: hypocalcemia • lead poisoning • medication error

Abbreviations: BLL, blood lead level • Na2EDTA, edetate disodium • CaNa2EDTA, edetate disodium calcium • IV, intravenous(ly) • CDC, Centers for Disease Control and Prevention • ED, emergency department

Accepted Apr 14, 2006.