Table 4 General guidance on chelation therapy and extracorporeal blood purification (EBP) in oliguric or anuric patients with lead and/or arsenic poisoning ^a

Acute severe Pb poisoning with encephalopathy

1st line:

BAL 4 mg/kg IM every 4-6  h [3, 22]

AND

CaNa₂EDTA 25-50 mg/kg (max 3 g) IV over 24 h on CRRT,

begin 4 h after BAL [41, 42, 44]

HDF or high-flux HD

CRRT if unstable or BAL is used

2^ndline:

CaNa₂EDTA 1 g IV over 1 h, give 1–3 h before HD or 25-50 mg/kg (max 3 g) IV over 24 h on CRRT [41, 42, 44]

OR

BAL 4 mg/kg IM every 4-6 h on CRRT [3, 22]

3rd line:

DMPS 3-5 mg/kg (max 250 mg) IV every 4 h [49,50,51] ^b

Acute Pb poisoning without encephalopathy but still requiring chelation

1st line:

CaNa₂EDTA 1 g IV over 1 h, give 1–3 h before HD or 25-50 mg/kg (max 3 g) IV over 24 h on CRRT [41, 42, 44]

HDF or high-flux HD

CRRT if unstable or BAL is used

2nd line:

DMPS 100-300 mg PO every 8 h [49, 52, 53]^b

3rd line:

BAL 4 mg/kg IM every 4-6 hours [3, 22]

Chronic Pb poisoning without encephalopathy requiring chelation

1st line:

CaNa₂EDTA 1 g IV over 1 h, give 1–3 h before HD or 25-50 mg/kg (max 3 g) IV over 24 h on CRRT [41, 42, 44]

HDF or high-flux HD

CRRT if unstable or BAL is used

PD could be considered if CaNa₂EDTA is used

2nd line:

DMPS 100-300 mg PO every 8 h [49, 52, 53]^b

3rd line:

BAL 4 mg/kg IM every 4-6 h [3, 22]

Ars poisoning (acutely ill)

1st line:

DMPS 3-5 mg/kg (max 250 mg) IV every 4 h [49,50,51]

HDF or high-flux HD

CRRT if unstable or BAL is used

2nd line:

BAL 4 mg/kg IM every 4-6 h [3, 22]

Ars poisoning (chronic / subacute) ^d

HDF or high-flux HD