Heavy metal poisoning | Chelation | EBP Modality | |
---|---|---|---|
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 |
2ndline: |
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 | ||
DMSA c | |||
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] | ||
DMSA c | |||
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] | ||
DMSA c | |||
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] | ||
DMSA c | |||
Ars poisoning (chronic / subacute) d | DMPS 100-300 mg PO every 8 h [52, 53] | HDF or high-flux HD |