Aggressive approach in the treatment of acute lead encephalopathy with an extraordinarily high concentration of lead.
OBJECTIVE
To report a case of a 3-year-old child with an extraordinarily massive lead concentration, 26.4 micromol/L (550 microg/dL), following environmental exposure to lead paint in the home.


METHODS
The relevant literature concerning the treatment of lead encephalopathy was reviewed during the treatment of this child and preparation of the manuscript. To our knowledge, the landmark article written by Julian Chisolm in 1968 is the only recent article that reported similarly high levels of lead concentration. This case, however, is the first in which 3 chelating agents were used for the treatment of lead encephalopathy. We also reviewed the literature on the use of whole bowel irrigation in heavy metal intoxications.


CONCLUSIONS
In this case, aggressive gut decontamination with whole bowel irrigation and triple chelation therapy with British anti-Lewisite, EDTA, and oral succimer was well tolerated and seemed effective for rapidly deleading the child. The extent to which her lead concentration increased while being treated with oral succimer alone necessitated further chelation with EDTA. Further evaluation is necessary to determine if triple chelation therapy is an appropriate method for severe lead intoxication, and if the use of whole bowel irrigation should be considered in heavy metal intoxication.
Gordon
R A
RA
Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago 60612, USA.
Roberts
G
G
Amin
Z
Z
Williams
R H
RH
Paloucek
F P
FP
D001927:Brain Diseases / Q000209:etiology* / Q000628:therapy; D002675:Child, Preschool; D004112:Dimercaprol / Q000627:therapeutic use; D004492:Edetic Acid / Q000627:therapeutic use; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000097:blood / Q000628:therapy*; D010150:Paint / Q000506:poisoning; D011092:Polyethylene Glycols / Q000008:administration & dosage; D004113:Succimer / Q000627:therapeutic use; D007507:Therapeutic Irrigation
D007502:Iron Chelating Agents; D004112:Dimercaprol; D007854:Lead; D011092:Polyethylene Glycols; D004492:Edetic Acid; D004113:Succimer