1 the Metabolism of Triphenyllead
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Review of Succimer for Treatment of Lead Poisoning
Review of Succimer for treatment of lead poisoning Glyn N Volans MD, BSc, FRCP. Department of Clinical Pharmacology, School of Medicine at Guy's, King's College & St Thomas' Hospitals, St Thomas' Hospital, London, UK Lakshman Karalliedde MB BS, DA, FRCA Consultant Medical Toxicologist, CHaPD (London), Health Protection Agency UK, Visiting Senior Lecturer, Division of Public Health Sciences, King's College Medical School, King's College , London Senior Research Collaborator, South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, Peradeniya, Sri Lanka. Heather M Wiseman BSc MSc Medical Toxicology Information Services, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK. Contact details: Heather Wiseman Medical Toxicology Information Services Guy’s & St Thomas’ NHS Foundation Trust Mary Sheridan House Guy’s Hospital Great Maze Pond London SE1 9RT Tel 020 7188 7188 extn 51699 or 020 7188 0600 (admin office) Date 10th March 2010 succimer V 29 Nov 10.doc last saved: 29-Nov-10 11:30 Page 1 of 50 CONTENTS 1 Summary 2. Name of the focal point in WHO submitting or supporting the application 3. Name of the organization(s) consulted and/or supporting the application 4. International Nonproprietary Name (INN, generic name) of the medicine 5. Formulation proposed for inclusion 6. International availability 7. Whether listing is requested as an individual medicine or as an example of a therapeutic group 8. Public health relevance 8.1 Epidemiological information on burden of disease due to lead poisoning 8.2 Assessment of current use 8.2.1 Treatment of children with lead poisoning 8.2.2 Other indications 9. -
Sodium Cellulose Phosphate Sodium Edetate
Sevelamer/Sodium Edetate 1463 excreted by the kidneys. It may be used as a diagnostic is not less than 9.5% and not more than 13.0%, all calculated on supplement should not be given simultaneously with test for lead poisoning but measurement of blood-lead the dried basis. The calcium binding capacity, calculated on the sodium cellulose phosphate. dried basis, is not less than 1.8 mmol per g. concentrations is generally preferred. Sodium cellulose phosphate has also been used for the Sodium calcium edetate is also a chelator of other Adverse Effects and Precautions investigation of calcium absorption. heavy-metal polyvalent ions, including chromium. A Diarrhoea and other gastrointestinal disturbances have Preparations cream containing sodium calcium edetate 10% has been reported. USP 31: Cellulose Sodium Phosphate for Oral Suspension. been used in the treatment of chrome ulcers and skin Sodium cellulose phosphate should not be given to pa- Proprietary Preparations (details are given in Part 3) sensitivity reactions due to contact with heavy metals. tients with primary or secondary hyperparathyroidism, Spain: Anacalcit; USA: Calcibind. Sodium calcium edetate is also used as a pharmaceuti- hypomagnesaemia, hypocalcaemia, bone disease, or cal excipient and as a food additive. enteric hyperoxaluria. It should be used cautiously in pregnant women and children, since they have high Sodium Edetate In the treatment of lead poisoning, sodium calcium calcium requirements. Sodu edetynian. edetate may be given by intramuscular injection or by Patients should be monitored for electrolyte distur- intravenous infusion. The intramuscular route may be Эдетат Натрия bances. Uptake of sodium and phosphate may increase CAS — 17421-79-3 (monosodium edetate). -
Uses and Administration Adverse Effects and Precautions Pharmacokinetics Uses and Administration
1549 The adverse effects of dicobalt edetate are more severe in year-old child: case report and review of literature. Z Kardiol 2005; 94: References. 817-2 3. the absence of cyanide. Therefore, dicobalt edetate should I. Schaumann W, et a!. Kinetics of the Fab fragments of digoxin antibodies and of bound digoxin in patients with severe digoxin intoxication. Eur 1 not be given unless cyanide poisoning is confirmed and 30: Administration in renal impairment. In renal impairment, Clin Pharmacol 1986; 527-33. poisoning is severe such as when consciousness is impaired. 2. Ujhelyi MR, Robert S. Pharmacokinetic aspects of digoxin-specific Fab elimination of antibody-bound digoxin or digitoxin is therapy in the management of digitalis toxicity. Clin Pharmacokinet 1995; Oedema. A patient with cyanide toxicity developed delayed1·3 and antibody fragments can be detected in the 28: 483-93. plasma for 2 to 3 weeks after treatment.1 The rebound in 3. Renard C, et al. Pharmacokinetics of dig,'><i<1-sp,eei1ie Fab: effects of severe facial and pulmonary oedema after treatment with decreased renal function and age. 1997; 44: 135-8. dicobalt edetate.1 It has been suggested that when dicobalt free-digoxin concentrations that has been reported after edetate is used, facilities for intubation and resuscitation treatment with digoxin-specific antibody fragments (see P (Jrations should be immediately available. Poisoning, below), occurred much later in patients with r.�p renal impairment than in those with normal renal func Proprietary Preparations (details are given in Volume B) 1. Dodds C, McKnight C. Cyanide toxicity after immersion and the hazards tion. -
Electroanalytical Chemistry of Some Organometallic Compounds of Tin, Lead and Germanium
ELECTROANALYTICAL CHEMISTRY OF SOME ORGANOMETALLIC COMPOUNDS OF TIN, LEAD AND GERMANIUM by Nani Bhushan Fouzder M.Sc. (Rajshahi) A Thesis Submitted for the Degree of Doctor of Philosophy of the University of London. Chemistry Department, Imperial College of Science and Technology, London S.W.7. September, 1975. 11 ABSTRACT. The present thesis concerns the investigation into the electrochemical behaviour of some industrially important organometallic compounds of tin, lead and germanium and development of suitable electrochemical methods for the analysis of these compounds at formula- tion and at trace level. The basic principles of the electrochemical techniques used inthis investigation have been given in the first part of the 'Introduction', while the various factors which control the electrode process have been discussed in the second part of the 'Introduction' in chapter 1. The electrochemical behaviour and analytical determination of some important organotin fungicides and pesticides such as tri-n-butyltin oxide, triphenyl- tin acetate, etc., some antihelminthic compounds such as dibutyltin dilaureate and dibutyltin dimaleate and some widely used PVC-stabilizers such as di-n-Octyltin dithioglycollic acid ester (Irgastab 17 MOK), Irgastab 17M and Irgastab 15 MOR have been described in the following three chapters. For each type of compound a detailed mechanism of the electrochemical process has been proposed and established. The electrochemical behaviour of organolead compounds and of the organogermanium compounds have been described in the next three chapters. In each case, the mechanism of reduction of these compounds has been established and methods 9fc their determina- tion at ordinary and at trace level have been developed. Finally, in the eighth chapter a brief intro- duction into the highspeed liquid chromatographic technique has been given and analysis of organotin compounds by this method using a wall-jet electrode detector has been described. -
Toxicological Profile for Lead
LEAD 355 CHAPTER 5. POTENTIAL FOR HUMAN EXPOSURE 5.1 OVERVIEW Pb and Pb compounds have been identified in at least 1,287 and 46 sites, respectively, of the 1,867 hazardous waste sites that have been proposed for inclusion on the EPA National Priorities List (NPL) (ATSDR 2019). However, the number of sites evaluated for Pb is not known. The number of sites in each state is shown in Figures 5-1 and 5-2, respectively. Of these 1,287 sites for Pb, 1,273 are located within the United States, 2 are located in the Virgin Islands, 2 are located in Guam, and 10 are located in Puerto Rico (not shown). All the sites for Pb compounds are only in the United States. Figure 5-1. Number of NPL Sites with Lead Contamination LEAD 356 5. POTENTIAL FOR HUMAN EXPOSURE Figure 5-2. Number of NPL Sites with Lead Compound Contamination • Pb is an element found in concentrated and easily accessible Pb ore deposits that are widely distributed throughout the world. • The general population may be exposed to Pb in ambient air, foods, drinking water, soil, and dust. For adults, exposure to levels of Pb beyond background are usually associated with occupational exposures. • For children, exposure to high levels of Pb are associated with living in areas contaminated by Pb (e.g., soil or indoor dust in older homes with Pb paint). Exposure usually occurs by hand-to- mouth activities. • As an element, Pb does not degrade. However, particulate matter contaminated with Pb can move through air, water, and soil. -
An Oral Treatment for Lead Toxicity Paul S
Postgrad Med J: first published as 10.1136/pgmj.67.783.63 on 1 January 1991. Downloaded from Postgrad MedJ (1991) 67, 63 - 65 D The Fellowship ofPostgraduate Medicine, 1991 Clinical Toxicology An oral treatment for lead toxicity Paul S. Thomas' and Charles Ashton2 'Northwick Park Hospital, Harrow, Middlesex HA] 3UJand2National Poisons Unit, Guy's Hospital, London SE], UK. Summary: Chronic lead poisoning has traditionally been treated by parenteral agents. We present a case where a comparison of ethylene diaminetetra-acetic acid was made with 2,3-dimethyl succinic acid (DMSA) which has the advantage oforal administration associated with little toxicity and appeared to be at least as efficacious. Introduction For many years the treatment of heavy metal ferase 112IU/I (normal<40). His electrolytes, poisoning has relied upon parenteral agents which urea, creatinine, clotting screening chest radio- themselves have a number of toxic side effects. We graph, computed tomographic head scan and lum- report a case ofplumbism which shows the benefits bar puncture were all normal. of using 2,3-dimethyl succinic acid (DMSA), a Re-evaluation revealed lead lines on his gingival treatment relatively new to Western countries. In margins and a urinary porphyrin screen was posi- by copyright. our case it was used in direct comparison to the tive indicating lead toxicity. Despite careful social, sodium-calcium salt of ethylene diaminetetra- occupational, and recreational history no cause for acetic acid, which has been the best available his excess lead intake could be found. As he was treatment. domiciled in India it was not possible to visit his home or workplace where he sold sarees. -
Antidotes Atropine Calcium
Version 2.9 Antidotes 4/10/2013 Atropine Indications AV conduction impairment: Cardiac glycosides , β-blockers , calcium channel blockers (CCBs) . Anticholinesterase inhibitors/Cholinergics: Organophosphates, carbamates Contraindications Relative: closed angle glaucoma, GIT obstruction, urinary obstruction Mechanism Competitive antagonist for ACh at muscarinic receptors. Pharmacokinetics Poor oral bioavailability, liver met, T ½=2-4hrs. Crosses BBB & placenta. 50% excreted unaltered. Administration AV conduction impairment: 0.6mg (20mcg/kg) IV repeated up to 3x Cholinergics: 1.2mg IV bolus, double dose q5mins until chest clear [also sBP>80mmHg, HR>80, dry axillae & no miosis]. Then infusion starting at ~10-20% of total loading dose (max 35mg/hr) Adverse Reactions Excessive dosage → Anticholinergic toxidrome. Calcium Indications CCB OD, HF exposure, hypocalcaemia, hyperkalaemia, iatrogenic hypermagnesaemia Contraindications Hypercalcaemia, ?digoxin toxicity - (contrary to traditional teaching, recently some evidence 2+ that Ca is not CI if on digoxin or even if digoxin toxic – however digoxin immune Fab & MgSO 4 10mmol might be preferred initially in the latter case) Mechanisms Restore low Ca2 + levels, binds F- ions, antagonises effects of high K + & Mg 2+ on heart. Administration Cardiac monitoring mandatory. CCBs: 20ml CaCl 2 IV (central line) or 60ml (1ml/kg) Ca gluconate IV (peripheral) over 5-10mins HF on skin: 2.5% Ca gel TOP OR local inj of 10% calcium gluconate (not fingers) OR Bier’s block with 2% Ca gluconate (i.e. 10ml of 10% in 40ml NS) for 20mins & release cuff OR same dose intra-arterially over 4 hrs & rpt prn. HF inhaled: Nebulised 2.5% Ca gluconate solution. HypoCa/HypoMg/HyperK: 5-10ml CaCl 2 or 10-20ml (1ml/kg) Ca gluconate IV over 5-10mins Adverse Reactions Transient hyperCa., vasodilatation, hypoBP, dysrhythmias, tissue damage from extravasated CaCl 2. -
United States Patent 0 ’ CC Patented Nov
2,859,225 United States Patent 0 ’ CC Patented Nov. 4, 1958 1 2 conversion of lead to tetraethyllead above that obtained in present commercial practice without requiring the use‘ 2,159,225 of metallic sodium, metallic lead, alkyl halogen com6 MANUFACTURE or ORGANOLEAD COMPOUNDS pounds, or lead halides. These and other objects of this invention are accom Sidney M. Blitzer and Tillmon H. Pearson, Baton Rouge, plished by reacting a lead chalko'gen, i. e., lead oxide or La., asignors to Ethyl Corporation, New York, N. Y., sul?de, with a non-lead metalloorganic compound of suf a corporation of Delaware ?cient stability under reaction conditions, where the organo portion is a hydrocarbon radical and wherein the No Drawing. Application March 25 1955 10 Serial No. 496,919 ’ metallo element is directly attached to carbon and may additionally be attached to another metallic element. In 13 Claims. (Cl. 260—437) certain embodiments of this invention it is preferred to employ a catalyst. The so-called metalloid elements are not contemplated as they do not form true metalloorganic This invention relates to a process for the manufacture compounds. Thus, this invention comprises the metatheti of organolead compounds. In particular, this invention is cal reaction between lead chalkogen and a non-lead metal directed to a novel process for the manufacture of tetra loorganic compound. 7 ethyllead from lead oxides and sul?des. In general, the metalloorganic reactants of the present The process employed in present commercial practice invention have the general formula M‘R, or M’MIR," for the manufacture of tetraethyllead has been in use for where M1 and M2 are true metals other than lead, R is a number of years and, in general, is satisfactory. -
Picture As Pdf Download
NOTABLE CASES Succimer therapy for congenital lead poisoning from maternal petrol sniffing An infant, born at 35 weeks’ gestation to a woman who sniffed petrol, had a cord blood lead level eight times the accepted limit. Treatment with oral dimercaptosuccinic acid promptly reduced his blood lead levels. To our knowledge, this is the first reported case of congenital lead poisoning secondary to maternal petrol sniffing. We suggest that at-risk pregnancies should be identified, cord blood lead levels tested, and chelation therapy and developmental follow-up offered to affected infants. (MJA 2006; 184: 84-85) Clinical record therapy is recommended for any child with blood lead levels of μ 3 A 27-year-old Indigenous woman, who had sniffed petrol since 2.16 mol/L and over. Although chelation therapy in early child- childhood, presented for antenatal care during her first pregnancy. hood lowers blood levels, recent studies have not shown signifi- At the age of 14 years, she had severe lead encephalopathy that led cant improvement in cognitive and behavioural measurements 3,4,7 to chronic neurological deficits, including permanent ataxia and compared with untreated children. memory impairment. Her serum lead levels at 8 and 35 weeks’ There are a few case reports of neonatal lead intoxication that gestation were raised at 1.48 and 2.21 μmol/L, respectively (recom- occurred from maternal exposure to lead through pica, home 8-10 mended level, р 0.48 μmol/L1). renovation, or use of contaminated herbal medications. Petrol At 35 weeks’ gestation, she went into spontaneous labour and sniffing is a form of substance misuse that is widespread in some gave birth vaginally to a boy. -
Oral Chelation Therapy for Patients with Lead Poisoning
ORAL CHELATION THERAPY FOR PATIENTS WITH LEAD POISONING Jennifer A. Lowry, MD Division of Clinical Pharmacology and Medical Toxicology The Children’s Mercy Hospitals and Clinics Kansas City, MO 64108 Tel: (816) 234-3059 Fax: (816) 855-1958 December 2010 1 TABLE OF CONTENTS 1. Background of Lead Poisoning …………………………………………………………...3 a. Clinical Significance of Lead Measurements …………………………………….3 b. Absorption of Lead and Its Internal Distribution Within the Body ………………3 c. Toxic Effects of Exposure to Lead in Children and Adults ………………………4 d. Reproductive and Developmental Effects………………………………………...5 e. Mechanisms of Lead Toxicity ……………………………………………………6 f. Concentration of Lead in Blood Deemed Safe for Children/Adults………………6 g. Use of Blood Lead Measurements as a Marker of Lead Exposure ……………….7 2. Management of the Child with Elevated Blood Lead Concentrations …………………...8 a. Decreasing Exposure……………………………………………………………...8 b. Chelation Therapy…………………………………………………………………8 3. Oral Chelation Therapy …………………………………………………………………...8 a. Meso-2,3 dimercaptosuccinic acid (DMSA, Succimer) …………………………8 i. Pharmacokinetics………………………………………………………….9 ii. Dosing …………………………………………………………………….9 iii. Efficacy……………………………………………………………………9 iv. Safety…………………………………………………………………….11 b. Racemic-2,3-dimercapto-1-propanesulfonic acid (DMPS, Unithiol)……………11 i. Pharmacokinetics………………………………………………………...12 ii. Dosing ……………………………………………………………………12 iii. Efficacy…………………………………………………………………..12 iv. Safety…………………………………………………………………….12 c. Penicillamine……………………………………………………………………..12 i. Pharmacokinetics………………………………………………………...13 -
Genesis and Evolution in the Chemistry of Organogermanium, Organotin and Organolead Compounds
CHAPTER 1 Genesis and evolution in the chemistry of organogermanium, organotin and organolead compounds MIKHAIL G. VORONKOV and KLAVDIYA A. ABZAEVA A. E. Favorsky Institute of Chemistry, Siberian Branch of the Russian Academy of Sciences, 1 Favorsky Str., 664033 Irkutsk, Russia e-mail: [email protected] The task of science is to induce the future from the past Heinrich Herz I. INTRODUCTION ..................................... 2 II. ORGANOGERMANIUM COMPOUNDS ...................... 5 A. Re-flowering after Half a Century of Oblivion ................. 5 B. Organometallic Approaches to a CGe and GeGe Bond ......... 6 C. Nonorganometallic Approaches to a CGe Bond ............... 11 D. CGe Bond Cleavage. Organylhalogermanes ................. 13 E. Compounds having a GeH Bond ........................ 14 F. Organogermanium Chalcogen Derivatives .................... 17 G. Organogermanium Pnicogen Derivatives ..................... 26 H. Compounds having a Hypovalent and Hypervalent Germanium Atom .................................... 29 I. Biological Activity ................................... 32 III. ORGANOTIN COMPOUNDS ............................. 33 A. How it All Began ................................... 33 B. Direct Synthesis ..................................... 36 C. Organometallic Synthesis from Inorganic and Organic Tin Halides ... 39 D. Organotin Hydrides .................................. 41 E. Organylhalostannanes. The CSn Bond Cleavage .............. 43 The chemistry of organic germanium, tin and lead compounds —Vol.2 Edited by -
Other Data Relevant to an Evaluation of Carcinogenicity and Its Mechanisms
P 201-252 DEF.qxp 09/08/2006 11:36 Page 249 INORGANIC AND ORGANIC LEAD COMPOUNDS 249 4. Other Data Relevant to an Evaluation of Carcinogenicity and its Mechanisms 4.1 Absorption, distribution, metabolism and excretion 4.1.1 Inorganic lead compounds (a) Humans (i) Absorption Absorption of lead is influenced by the route of exposure, the physicochemical charac- teristics of the lead and the exposure medium, and the age and physiological status of the exposed individual (e.g. fasting, concentration of nutritional elements such as calcium, and iron status). Inorganic lead can be absorbed by inhalation of fine particles, by ingestion and, to a much lesser extent, transdermally. Inhalation exposure Smaller lead particles (< 1 µm) have been shown to have greater deposition and absorption rates in the lungs than larger particles (Hodgkins et al., 1991; ATSDR, 1999). In adult men, approximately 30–50% of lead in inhaled air is deposited in the respiratory tract, depending on the size of the particles and the ventilation rate of the individual. The proportion of lead deposited is independent of the absolute lead burden in the air. The half- life for retention of lead in the lungs is about 15 h (Chamberlain et al., 1978; Morrow et al., 1980). Once deposited in the lower respiratory tract, particulate lead is almost completely absorbed, and different chemical forms of inorganic lead seem to be absorbed equally (Morrow et al., 1980; US EPA, 1986). In two separate experiments, male adult volunteers were exposed to aerosols of lead oxide (prepared by bubbling propane through a solution of tetraethyl lead in dodecane and burning of resulting vapour) containing 3.2 µg/m3 lead (15 subjects) or 10.9 µg/m3 lead (18 subjects) in a room for 23 h/day for up to 18 weeks (Griffin et al., 1975a).