PEDIATRICS Vol. 53 No. 3 March 1974, pp. 441-443
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Chelation Therapy in Children With Subclinical Plumbism

J. Julian Chisolm Jr. M.D.1

1 Department of Pediatrics, Baltimore City Hospitals, The John F. Kennedy Institute, and Happy Hills Hospital, Inc., Baltimore, Maryland

Findings in a recent study1 are consistent with the hypothesis that the total body lead burden is divided among three major compartments: (1) a rapidly exchangeable pool consisting of lead in blood and some soft tissue components; (2) another rapidly exchangeable pool consisting primarily of lead in soft tissue and lead loosely bound to bone; and (3) a very large portion (60% to 90% of the total burden2) tightly bound in the skeleton, with a turnover time estimated as one to two decades.

This third large pool is not associated with any known toxicity: it may be considered a "sink" which probably is virtually inaccessible to chelating agents. The effectiveness of chelating agents is associated with their ability to reduce the concentrations of lead in the two small, but mobile compartments where toxic effects do occur. The "metabolically active" fraction3,4 of the total body lead burden is probably similar to the "rapidly exchangeable" compartments.

The three chelating agents used to treat plumbism in the United States are edathamil calcium disodium (CaEDTA), 2,3-dimercaptopropanol (BAL) and d-penicillamine (PCA). PCA is available in oral dosage form only (250-mg capsules) and is classified by the FDA as an investigational drug if used for lead poisoning. When equimolar amounts of these agents were infused in rats under identical experimental conditions, PCA was appreciably inferior to CaEDTA and BAL in terms of the quantity of lead mobilized and excreted.5,7 Furthermore, a transitory increase in the lead content of some soft tissues was noted during mobilization with PCA, but not with either CaEDTA or BAL.




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M. E. Mortensen and P. D. Walson
Chelation Therapy for Childhood Lead Poisoning: The Changing Scene in the 1990s
Clinical Pediatrics, May 1, 1993; 32(5): 284 - 291.
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