title: Comparison of dimercaptosuccinic acid and calcium disodium ethylenediaminetetraacetic acid versus dimercaptopropanol and ethylenediaminetetraacetic acid in children with lead poisoning.
abstract: OBJECTIVE
  To compare the response to dimercaptopropanol (BAL) and calcium disodium ethylenediaminetetraacetic acid (EDTA) versus orally administered meso-2,3-dimercaptosuccinic acid (DMSA) and EDTA in children with lead poisoning.
  
  
  METHODS
  Retrospective review of medical records of children admitted to MetroHealth Medical Center with a whole blood lead (BPb) concentration of 2.17 mumol/L (45 micrograms/dl) or more (or less than 2.17 mumol/L and not a candidate for outpatient oral chelation) and treated with BAL + EDTA or DMSA + EDTA. In each group, the mean BPb values at the end of therapy and at 14 and 33 days after chelation were compared with pretreatment BPb by the Wilcoxon signed-rank test, whereas the Mann-Whitney U test was used to compare percentage change from pretreatment at each follow-up day between the two groups.
  
  
  RESULTS
  Twenty-three children received BAL + EDTA and 22 received DMSA + EDTA. The BPb values (mean +/- SD) at the end of therapy and at 14 and 33 days after chelation were significantly lower than pretreatment in both groups (BAL + EDTA: 17 +/- 10, 34 +/- 7, 36 +/- 11 vs 58 +/- 14 micrograms/dl, p < 0.02, 0.01, 0.001, respectively; DMSA + EDTA: 10 +/- 4, 30 +/- 10, 30 +/- 14 vs 50 +/- 10 micrograms/dl, p < 0.01, 0.001, 0.01, respectively). The percentage reduction (mean +/- SD) in BPb from pretreatment at the end of therapy and on days 14 and 33 after chelation did not differ between the groups (BAL + EDTA: -71.2% +/- 19.8%, -40.2% +/- 13.8%, -37.1% +/- 17%; DMSA + EDTA: -79.9% +/- 8.7%, -38.3% +/- 21.6%, -37% +/- 32%; p > 0.20). Elevation of alanine aminotransferase and vomiting during therapy were observed more frequently in the BAL + EDTA group compared with the DMSA + EDTA group.
  
  
  CONCLUSIONS
  Treatment with DMSA or BAL combined with EDTA results in a comparable reduction in BPb.
authors.affiliation: Department of Pediatrics, MetroHealth Medical Center, Cleveland, OH 44109-1998, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Besunder
authors.forename: D M
authors.initials: DM
authors.lastname: Super
authors.forename: R L
authors.initials: RL
authors.lastname: Anderson
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001806:Blood Urea Nitrogen; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D004492:Edetic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006454:Hemoglobins; D006801:Humans; D007855:Lead Poisoning / Q000097:blood / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies; D004113:Succimer / Q000009:adverse effects / Q000627:therapeutic use*; D014839:Vomiting / Q000209:etiology
chemical_list: D006454:Hemoglobins; D004492:Edetic Acid; D003404:Creatinine; D004113:Succimer; D000410:Alanine Transaminase