906 LEAD POISONING- COTTER J.A.MA, July 3, 1954
TREATMENT OF LEAD POISONING
BY CHELATION
Lawrence H. Cotter, M.D., New York
Chelating agents have been used
in industry for some time. The substance under consideration here, ethylene
diamine tetra-acetic acid, with the structural formula shown in the figure, has
proved valuable for recovering trace metals from foods and beverages and rare
metals in analyzing solutions. Pathologists find it useful in decalcifying bone,
and Gellhorn and others have used it clinically in reducing hypercalcemia. The
effects of the calcium chelate on the excretion and storage of lead were studied
by Rubin in his experiments on rabbits. Many other animal studies have been
reported, and it is in fairly general use by veterinarians. Busman, Reid and
Rubin reported a case in 1952 in which lead encephalopathy in a human being was
successfully treated by intravenous injection of calcium disodium Versenate. The
same year Belknap obtained excellent results in three cases with the same
treatment. Popovici and associates found that the chelating agent was absorbed
through the skin in human beings with resultant diminution of the serum calcium.
The practicability of oral administration was, therefore, established, but there
remained the danger of eliminating the normal plasma electrolytes coincidentally
with lead. The recent development of a disodium calcium salt of the amino acid (Versene)
made treatment possible without this disadvantage. It further proved to be
pleasant to take, whereas all patients had complained of the persistent
nauseating taste of the acid. The method employee in this series was to give a
test dose of 25mg of Versene by mouth. If no allergic symptoms were observed at
the end of 24 hours, the initial dose was repeated every 2 hours during the day
until a total of 2gm had been given. This was continued for a week, by which
time the patient had received 14gm. There were no complaints, and most of the
patients volunteered the information that they felt an urge to urinate about 15
minutes after taking the pills
HOOC-CH2
CH2-COOH
N-CH2-CH2-N
HOOC-CH2 CH2-COOH
From the Department of Medicine, Columbia University, College of Physicians
and surgeons, and Presbyterian Hospital.
Plumb, M, and Bersworth, FC: Displacement Series of Metal Complexes of EDTA, J.
Pys Colloid Chem. 54:1208, 1950.
Pharmacology, Physiology, Biochemistry and Toxicity of Versenes, Framingham,
MASS, Bersworth Chemical co, Sept 19, 1952
Birge, E.A. and Imhoff, C.E.: Versenate as Decalcifying Agent for Bone, Am. J.
Clin. Path. 22:192, 1952. Hahn, F.L., and Reygadas, F; Demineralization of Hard
Tissues, Science 114;462, 1951
Gellhorn, A: Personal communication to author.
Rubin, M: Gignac, S, and Popovici, A: Effect of Calcium Verseante on Storage and
Excretion of Lead in Rabbits, abstracted, J. Am. Chem.. Soc. 121:3J, 1952.
Holm, L.W.: Wheat, J.D.; Rhode, E.A.; and Firch, G: Treatment of Chronic Lead
Poisoning in Horses with Calcium disodium Ethylenediaminetetraacetate, J. am.
Bet. M.A. 123:38, 1953.
Bessman, S.P: Reid, H, and Rubin, M: Treatment of Lead Encephalopathy with
Calcium Disodium Versenate: Report of Case, M. Ann, District of Columbia 21:312,
1952.
Belknap, E.L: EDTA in Treatment of Lead Poisoning, Indust. Med. 21:305, 1952.
Popovici, A; Geschickter, C.F; Reinovsky, A and Rubin, M: Experimental Control
of Serum Calcium Levels in Vivo, Proc. Soc. Exper. Biol. & Med. 74:415, 1950.
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