Environmental Investigations
government programs provide intervention for<unk>  levels > 10ug/dl
Chelation:
Treat children with acute blood<unk>  levels >45ug/dL or chronic >70ug/dL
Consider treating symptomatic adults with<unk>  >50ug/dL or asymptomatic >70ug/dL
Penicillamine and Succimer
Oral medications
Only used in children 
Succimer has not been studied for<unk>  levels >60ug/dL
Succimer 10mg/kg TID x 5d THEN 10mg/kg BID x 14d
Penicillamine: second or third-line agent, requires B6 supplementation, contraindicated in patients allergic to penicillin, not approved during pregnancy, more toxic than Succimer
Penicillamine dose: 20-40 mg/kg/day PO divided q8hr
Penicillamine reported adverse effects include: rash, fever, anorexia, leukopenia, thrombocytopenia, hemolytic anemia, SJS, nephrotoxicity, proteinuria
IM BAL (dimercaprol)
First line agent if encephalopathy present
Consider giving first before EDTA, regardless of encephalopathy
As EDTA, if given first, may chelate<unk>  and cross blood brain barrier
Onet of action 30 minutes
Increases fetal excretion of<unk>  as chelated<unk>  is excreted primarily in bile after 4-6 hours
Also increases urinary excretion of chelated<unk> 
Agent of choice in renal failure
Dosage of 50-75mg/m^2 every 4 hours, full course is 3-5 days
Contraindications: liver failure, G6PD (develop hemolysis), peanut oil allergy, pregnancy
IV/IM EDTA (edetate calcium disodium)
Do not use as sole agent if encephalopathy present (does not cross blood-brain barrier)
Must have given BAL for at least 4h if<unk>  >100ug/dL or encephalopathy present
Increases renal excretion of<unk>  20-50 times
Children: 1-1.5gm/m^2/24hrs given in up to 6 divided daily doses
Adults: 1.5gm/24hrs in 2 divided doses
Full course of treatment is 5 days, may be repeated if patient still symptomatic or PbB > 50ug/dl
government programs provide intervention for<unk>  levels > 10ug/dl
Treat children with acute blood<unk>  levels >45ug/dL or chronic >70ug/dL
Consider treating symptomatic adults with<unk>  >50ug/dL or asymptomatic >70ug/dL
Oral medications
Only used in children 
Succimer has not been studied for<unk>  levels >60ug/dL
Succimer 10mg/kg TID x 5d THEN 10mg/kg BID x 14d
Penicillamine: second or third-line agent, requires B6 supplementation, contraindicated in patients allergic to penicillin, not approved during pregnancy, more toxic than Succimer
Penicillamine dose: 20-40 mg/kg/day PO divided q8hr
Penicillamine reported adverse effects include: rash, fever, anorexia, leukopenia, thrombocytopenia, hemolytic anemia, SJS, nephrotoxicity, proteinuria
First line agent if encephalopathy present
Consider giving first before EDTA, regardless of encephalopathy
As EDTA, if given first, may chelate<unk>  and cross blood brain barrier
Onet of action 30 minutes
Increases fetal excretion of<unk>  as chelated<unk>  is excreted primarily in bile after 4-6 hours
Also increases urinary excretion of chelated<unk> 
Agent of choice in renal failure
Dosage of 50-75mg/m^2 every 4 hours, full course is 3-5 days
Contraindications: liver failure, G6PD (develop hemolysis), peanut oil allergy, pregnancy
Consider giving first before EDTA, regardless of encephalopathy
As EDTA, if given first, may chelate<unk>  and cross blood brain barrier
Do not use as sole agent if encephalopathy present (does not cross blood-brain barrier)
Must have given BAL for at least 4h if<unk>  >100ug/dL or encephalopathy present
Increases renal excretion of<unk>  20-50 times
Children: 1-1.5gm/m^2/24hrs given in up to 6 divided daily doses
Adults: 1.5gm/24hrs in 2 divided doses
Full course of treatment is 5 days, may be repeated if patient still symptomatic or PbB > 50ug/dl
Lead toxicity
Aluminum toxicity
Gold toxicity
Antimony toxicity
Mercury toxicity
Arsenic toxicity
Copper toxicity
Barium toxicity