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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: 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
Most common cause of acute heavy metal toxicity
Methylated in liver & eliminated in urine
Treatment: Dimercaprol or Unithiol
Interferes w/ biosynthesis of heme - GI is major route of lead poisoning
Toxicity: anemia, hearing defects, encephalopathy, elevated BP
Treatment: EDTA (adults) & Succimer (children)
Toxicity: chronic exposure - excitability, neuropsychiatric disturbances, and gingivostomatitis
Treatment: Dimercaprol (unithiol & succimer)
Respiratory tract is main site of absorption - fibrosis & emphysema, also liver & renal toxicity
Treatment: supportive therapy - NO CHELATION theraphy
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)
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