What is the treatment for lead poisoning (plumbism)?

From the Guidelines

Treatment for lead poisoning primarily involves removing the source of exposure and using chelation therapy to eliminate lead from the body, with the goal of reducing morbidity, mortality, and improving quality of life. According to the most recent and highest quality study 1, for severe cases with blood lead levels above 45 μg/dL, chelation therapy is recommended. The American Academy of Pediatrics recommends the following treatment guidelines:

• For blood lead levels between 15-44 μg/dL, confirm the blood lead concentration with repeat venous sample within 1-4 weeks, and consider abdominal radiography and gut decontamination if leaded foreign bodies are visualized.
• For blood lead levels above 44 μg/dL, confirm the blood lead concentration with repeat venous lead level within 48 hours, and consider hospitalization or chelation therapy. Some key points to consider in the treatment of lead poisoning include:
• Removing the source of exposure to prevent further lead absorption
• Using chelation therapy to eliminate lead from the body
• Providing supportive care, including proper nutrition with adequate iron, calcium, and vitamin C
• Monitoring patients with follow-up blood tests to ensure lead levels are decreasing
• Identifying and removing lead sources from the environment, such as lead paint, contaminated soil, or water, to prevent further exposure. It's also important to note that children are particularly vulnerable to lead's neurotoxic effects, so early intervention is critical to prevent permanent neurological damage. Even low levels of lead exposure can cause cognitive impairment, so treatment should begin as soon as elevated levels are detected 1.

From the FDA Drug Label

When a source for the lead intoxication has been identified, the patient should be removed from the source, if possible The recommended dose of edetate calcium disodium for asymptomatic adults and pediatric patients whose blood lead level is < 70 mcg/dl but > 20 mcg/dl ... is 1000 mg/m2/day Edetate calcium disodium, used alone, may aggravate symptoms in patients with very high blood lead levels. When the blood lead level is > 70 mcg/dl or clinical symptoms consistent with lead poisoning are present, it is recommended that edetate calcium disodium be used in conjunction with BAL (dimercaprol)

The treatment for lead poisoning involves:

• Removing the patient from the source of lead intoxication, if possible
• Administering edetate calcium disodium at a dose of 1000 mg/m2/day for asymptomatic patients with blood lead levels between 20-70 mcg/dl
• Using edetate calcium disodium in conjunction with BAL (dimercaprol) for patients with blood lead levels above 70 mcg/dl or clinical symptoms consistent with lead poisoning 2

From the Research

Treatment Options for Lead Poisoning

• Chelation therapy is a common treatment approach for lead poisoning, which involves using agents to remove lead from the body 3, 4, 5, 6.
• The primary agents used for chelation are dimercaprol, edetate calcium disodium, and succimer, with succimer being an effective oral antidote for lead poisoning 4, 5, 6.
• Sodium calcium edetate and succimer have been compared in several studies, with both agents showing similar efficacy in enhancing urine lead excretion and lowering blood lead concentrations 6.

Chelation Therapy Guidelines

• Children with a blood lead concentration of >10 microg/dL and adults with a blood lead concentration of > or = 45 microg/dL should undergo further evaluation and potential chelation therapy 3.
• Chelation is generally not indicated for adults with blood lead concentrations of < 45 microg/dL due to the potential risk of adverse drug events and concerns about remobilized lead 3.
• The dosage and duration of chelation therapy may vary depending on the severity of lead poisoning and the individual's response to treatment 4, 5.

Adverse Effects and Considerations

• Chelation therapy can cause adverse effects such as nephrotoxicity, zinc and copper depletion, and skin lesions 4, 5, 6.
• Oral DMSA may be associated with a severe mucocutaneous reaction, and sodium calcium edetate can cause dose-related nephrotoxicity 4, 6.
• The choice of chelation agent and treatment approach should be individualized based on the patient's specific needs and circumstances 3, 6.