Antiemetics
Fluid and electrolyte repletion
GI decontamination unlikely to benefit
Activated charcoal contraindicated
Recommended in cases with hematologic or hepatic complications
Most commonly used are BAL and D-penicillamine
British anti-Lewisite (BAL)
Beneficial in patients with vomiting who are unable to take D-penicillamine
Useful in those with renal failure
D-penicillamine
Should be started as soon as able to tolerate PO
Begin simultaneously with BAL or soon after
Prevents<unk>  induced hemolysis in patients with wilson disease
Undergoes renal clearance
1.0-1.5 g/d given PO in 4 divided doses
Can be used for acute and chronic<unk>  poisoning
Complications
Worsening of neurologic findings
Aplastic anemia
Agranulocytosis
Renal and pulmonary disease
Hypersensitivity reactions in 25% of patients with pencillin allergies
Congenital abnormaliies in pregnenancy
CaNa2EDTA
Will reduce oxidative damage
Does not enhance elimination
Succimer
Ineffective<unk>  chelator
Does increase<unk>  elimination in murine models
Dose is the same as lead dosing
DMPS
Not recommended for treatment of<unk>  poisoning
Can worsen<unk>  induced hemolysis
Trientine
Second line chelator for wilson disease
No reports in acute<unk>  poisoning
Tetrathiomolybdate
FDA chelating agent with orphan drug status
No human studies but showed benefits in animal models
Beneficial in patients with vomiting who are unable to take D-penicillamine
Useful in those with renal failure
Should be started as soon as able to tolerate PO
Begin simultaneously with BAL or soon after
Prevents<unk>  induced hemolysis in patients with wilson disease
Undergoes renal clearance
1.0-1.5 g/d given PO in 4 divided doses
Can be used for acute and chronic<unk>  poisoning
Complications
Worsening of neurologic findings
Aplastic anemia
Agranulocytosis
Renal and pulmonary disease
Hypersensitivity reactions in 25% of patients with pencillin allergies
Congenital abnormaliies in pregnenancy
Worsening of neurologic findings
Aplastic anemia
Agranulocytosis
Renal and pulmonary disease
Hypersensitivity reactions in 25% of patients with pencillin allergies
Congenital abnormaliies in pregnenancy
Will reduce oxidative damage
Does not enhance elimination
Ineffective<unk>  chelator
Does increase<unk>  elimination in murine models
Dose is the same as lead dosing
Not recommended for treatment of<unk>  poisoning
Can worsen<unk>  induced hemolysis
Second line chelator for wilson disease
No reports in acute<unk>  poisoning
FDA chelating agent with orphan drug status
No human studies but showed benefits in animal models
Unlikely to benefit
Exchange transfustion
Limited benefit
Hemodialysis
Not recommended
Membranes allow<unk>  ions to cross
Unlikely to be clinnicall useful
May also lyse erythrocytes release stored<unk>  causing worsening toxicity
Molecular adsorbents recirculating system (MARS) and Single Pass Albumin Dialysis (SPAD)
Rapidly and substantially lower serum<unk>  concentraions
Risk of hemolysis
Plasma Exchange
Enhanced elimination of<unk>  by 3-12 mg
Unclear if benficial after large ingestions
Risk of hemolysis
Peritoneal Dialysis
Not useful
Limited benefit
Not recommended
Membranes allow<unk>  ions to cross
Unlikely to be clinnicall useful
May also lyse erythrocytes release stored<unk>  causing worsening toxicity
Rapidly and substantially lower serum<unk>  concentraions
Risk of hemolysis
Enhanced elimination of<unk>  by 3-12 mg
Unclear if benficial after large ingestions
Risk of hemolysis
Not useful
Copper toxicity
Also seen in Wilson's disease
Gold toxicity
Aluminum toxicity
Zinc toxicity
Antimony toxicity
Mercury toxicity
Arsenic toxicity