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Indication: ARSENIC & inorganic MERCURY (Hg) poisoning (don't use w/ methylmercury poisoning)

Toxicity: hypertension, tachycardia, N&V, fever, and pain at injection site


Indication: acute IRON (Fe) poisoning

Highly selective Fe chelator that doesn't interfere w/ iron binding to hemoglobin, myoglobin, or cytochromes

Toxicity: hypotension, flushing, abdominal discomfort, rash, and increased susceptibility to infection w/ long-term use


Indication: chronic IRON (Fe) poisoning

Oral administration & excreted in bile

Edetate (EDTA)

Indication: LEAD poisoning in adults (also chelates calcium, zinc, magnesium)

Mainly chelates EXTRACELLULAR IONS (not well absorbed from gut, crosses membranes very poorly) - ON/OFF cycles to allow Pb to redistribute out of bone


Indication: LEAD poisoning in children

Water soluble analog of dimercaprol


Indication: acute poisoning w/ ARSENIC & inorganic MERCURY

Arsenic (As)

Most common cause of acute heavy metal toxicity

Methylated in liver & eliminated in urine

Treatment: Dimercaprol or Unithiol

Lead (Pb)

Interferes w/ biosynthesis of heme - GI is major route of lead poisoning

Toxicity: anemia, hearing defects, encephalopathy, elevated BP

Treatment: EDTA (adults) & Succimer (children)

Mercury (Hg)

Toxicity: chronic exposure - excitability, neuropsychiatric disturbances, and gingivostomatitis

Treatment: Dimercaprol (unithiol & succimer)

Cadmium (Cd)

Respiratory tract is main site of absorption - fibrosis & emphysema, also liver & renal toxicity

Treatment: supportive therapy - NO CHELATION theraphy

Iron (Fe)

Acute poisoning almost always in children

Iron Intoxication: Phase I (gastrointestinal - 30 min to 2hrs - vomiting, hematemesis, abd. pain), Phase II (recovery - 2 to 24 hrs - apparent response to therapy), Phase III (metabolic acidosis - 12 to 48 hrs - comma & death)

Treatment: Deferoxamine

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