+ CDC management guidelines for children with elevated blood levels Blood<unk>  level (μg/dL) Treatment 10–14 Education, repeat screening 15–19 Repeat screening, case management to abate sources 20–44 Medical evaluation, case management 45–69 Medical evaluation, chelation, case management >69 Hospitalization, immediate chelation, case management The mainstays of treatment are removal from the source of<unk>  and, for people who have significantly high blood<unk>  levels or who have symptoms of poisoning, chelation therapy. Treatment of iron, calcium, and zinc deficiencies, which are associated with increased<unk>  absorption, is another part of treatment for<unk> . When<unk> -containing materials are present in the gastrointestinal tract (as evidenced by abdominal X-rays), whole bowel irrigation, cathartics, endoscopy, or even surgical removal may be used to eliminate it from the gut and prevent further exposure.<unk> -containing bullets and shrapnel may also present a threat of further exposure and may need to be surgically removed if they are in or near fluid-filled or synovial spaces. If<unk>  encephalopathy is present, anticonvulsants may be given to control seizures, and treatments to control swelling of the brain include corticosteroids and mannitol. Treatment of organic<unk>  involves removing the<unk>  compound from the skin, preventing further exposure, treating seizures, and possibly chelation therapy for people with high blood<unk>  concentrations. chelating agent, binds a heavy metal, sequestering it.|alt=a chemical diagram of CH2N(CH2CO2-)22 (shown in black) with the four O- tails binding a metal ion (shown in red). A chelating agent is a molecule with at least two negatively charged groups that allow it to form complexes with metal ions with multiple positive charges, such as<unk> . The chelate that is thus formed is nontoxic and can be excreted in the urine, initially at up to 50 times the normal rate. The chelating agents used for treatment of<unk>  are edetate disodium calcium (CaNa2EDTA), dimercaprol (BAL), which are injected, and succimer and d-penicillamine, which are administered orally. Chelation therapy is used in cases of acute<unk> , severe poisoning, and encephalopathy, and is considered for people with blood<unk>  levels above 25 µg/dL. While the use of chelation for people with symptoms of<unk>  is widely supported, use in asymptomatic people with high blood<unk>  levels is more controversial. Chelation therapy is of limited value for cases of chronic exposure to low levels of<unk> . Chelation therapy is usually stopped when symptoms resolve or when blood<unk>  levels return to premorbid levels. When<unk>  exposure has taken place over a long period, blood<unk>  levels may rise after chelation is stopped because<unk>  is leached into blood from stores in the bone; thus repeated treatments are often necessary. People receiving dimercaprol need to be assessed for peanut allergies since the commercial formulation contains peanut oil. Calcium EDTA is also effective if administered four hours after the administration of dimercaprol. Administering dimercaprol, DMSA (Succimer), or DMPS prior to calcium EDTA is necessary to prevent the redistribution of<unk>  into the central nervous system. Dimercaprol used alone may also redistribute<unk>  to the brain and testes. An adverse side effect of calcium EDTA is renal toxicity. Succimer (DMSA) is the preferred agent in mild to moderate<unk>  cases. This may be the case in instances where children have a blood<unk>  level >25μg/dL. The most reported adverse side effect for succimer is gastrointestinal disturbances. It is also important to note that chelation therapy only lowers blood<unk>  levels and may not prevent the<unk> -induced cognitive problems associated with lower<unk>  levels in tissue. This may be because of the inability of these agents to remove sufficient amounts of<unk>  from tissue or inability to reverse preexisting damage. Chelating agents can have adverse effects; for example, chelation therapy can lower the body's levels of necessary nutrients like zinc. Chelating agents taken orally can increase the body's absorption of<unk>  through the intestine. Chelation challenge, also known as provocation testing, is used to indicate an elevated and mobilizable body burden of heavy metals including<unk> . This testing involves collecting urine before and after administering a one-off dose of chelating agent to mobilize heavy metals into the urine. Then urine is analyzed by a laboratory for levels of heavy metals; from this analysis overall body burden is inferred. Chelation challenge mainly measures the burden of<unk>  in soft tissues, though whether it accurately reflects long-term exposure or the amount of<unk>  stored in bone remains controversial. Although the technique has been used to determine whether chelation therapy is indicated and to diagnose heavy metal exposure, some evidence does not support these uses as blood levels after chelation are not comparable to the reference range typically used to diagnose heavy metal poisoning. The single chelation dose could also redistribute the heavy metals to more sensitive areas such as central nervous system tissue.
Lead poisoning
Anxiety disorder
Mercury poisoning
Iron-deficiency anemia
Zinc toxicity
Malabsorption
Iron poisoning
Polyneuropathy