What are the adverse reactions (ADRs) of EDTA (ethylenediaminetetraacetic acid) injection?

Adverse Reactions of EDTA Injection

EDTA injections can cause potentially life-threatening adverse reactions including hypocalcemia, renal failure, and death, and should not be used for conditions like peripheral arterial disease or cardiovascular disease due to lack of efficacy and significant safety concerns. 1

Major Adverse Reactions

Severe/Life-Threatening Reactions

• Hypocalcemia: Can be life-threatening and is one of the most serious concerns 2
• Acute renal tubular necrosis: May result in fatal nephrosis 1
• Cardiac rhythm irregularities: Can occur due to electrolyte imbalances 1

Cardiovascular Effects

• Hypotension 1
• Cardiac arrhythmias related to electrolyte disturbances 1

Renal Effects

• Acute necrosis of proximal tubules 1
• Changes in distal tubules and glomeruli (less frequent) 1
• Proteinuria 1
• Glycosuria 1
• Microscopic hematuria 1

Gastrointestinal Effects

• Nausea and vomiting 1
• Anorexia 1
• Excessive thirst 1
• Cheilosis (cracking at corners of mouth) 1

Other Adverse Reactions

Neurological

• Headache 1
• Numbness and tingling 1
• Tremors 1

Systemic

• Pain at injection site (for intramuscular administration) 1
• Fever and chills 1
• Malaise and fatigue 1
• Myalgia and arthralgia (muscle and joint pain) 1

Metabolic

• Zinc deficiency 1
• Hypercalcemia (paradoxically) 1

Hepatic

• Mild increases in liver enzymes (SGOT and SGPT) 1

Immunologic

• Histamine-like reactions (sneezing, nasal congestion, lacrimation) 1
• Skin rash 1

Hematologic

• Transient bone marrow depression 1
• Anemia 1

Important Considerations and Contraindications

Special Populations at Risk

• Patients with lead encephalopathy: Particularly dangerous in pediatric patients where mortality rates are high 1
• Patients with cerebral edema: May experience lethal increases in intracranial pressure with IV infusion 1

Administration Warnings

• Intramuscular route is preferred for patients with lead encephalopathy or cerebral edema 1
• If IV route is necessary, rapid infusion must be avoided 1
• Recommended daily dose should never be exceeded 1

Inappropriate Uses and Warnings

EDTA chelation therapy is not recommended for:

• Treatment of peripheral arterial disease/intermittent claudication 2
• Treatment of chronic angina or arteriosclerotic cardiovascular disease 2

Multiple guidelines specifically warn against using EDTA for these conditions due to:

1. Lack of efficacy in improving walking distance or reducing atherosclerosis 2
2. Potential to cause serious harm, particularly hypocalcemia 2
3. No evidence supporting its use in cardiovascular conditions 2

Monitoring Recommendations

For patients receiving EDTA injections for approved indications (such as heavy metal poisoning):

• Monitor serum calcium levels closely 1
• Monitor renal function 1
• Monitor complete blood counts 1
• Monitor liver function tests 1
• Follow recommended dosing schedule strictly 1

EDTA injections carry significant risks and should only be used for FDA-approved indications such as heavy metal poisoning, with careful monitoring and adherence to dosing guidelines.