title: Management of Lead Encephalopathy with DMSA After Exposure to Lead-Contaminated Moonshine.
abstract: BACKGROUND
  Lead encephalopathy is a severe manifestation of lead poisoning that can present with altered mental status and seizures and has been associated with illicit moonshine consumption. Lead encephalopathy has traditionally been treated using dimercaprol (British anti-Lewisite, BAL) and calcium disodium ethylenediaminetetraacetic acid (CaNa2EDTA).
  
  
  METHODS
  We describe a patient with lead encephalopathy related to lead-contaminated moonshine consumption, who was treated using dimercaptosuccinic acid (DMSA) due to a national shortage of CaNa2EDTA. A 66-year-old woman presented to a hospital with headache, irritability, and altered mental status. On hospital day 16, she was found to have a whole blood lead concentration of 148.2 μg/dL and a 24-h urine lead concentration of 232 μg/day. Due to a national shortage of CaNa2EDTA, the patient was given one dose of BAL and then started on DMSA via nasogastric tube. She dramatically improved over 4 days and was subsequently transitioned to oral DMSA and outpatient treatment. One day prior to discharge, her whole blood lead concentration was 47.2 μg/dL and her mental status was normal. DMSA was used in lieu of CaNa2EDTA to treat the patient with lead encephalopathy. The patient subsequently experienced clinical improvement and declining whole blood level concentrations.
  
  
  CONCLUSIONS
  Further prospective studies are needed to compare the efficacy of DMSA versus CaNa2EDTA in patients with lead encephalopathy.
authors.affiliation: Department of Emergency Medicine, Emory University, 531 Asbury Circle, Annex Building Suite N340, Atlanta, GA, 30322, USA. jarnold25@gmail.com.|Georgia Poison Center, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA. jarnold25@gmail.com.
authors.forename: Justin
authors.initials: J
authors.lastname: Arnold
authors.affiliation: Department of Emergency Medicine, Emory University, 531 Asbury Circle, Annex Building Suite N340, Atlanta, GA, 30322, USA.|Georgia Poison Center, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Morgan
mesh_terms: D000368:Aged; D001927:Brain Diseases / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D005506:Food Contamination; D006801:Humans; D007855:Lead Poisoning / Q000188:drug therapy*; D004113:Succimer / Q000627:therapeutic use*
chemical_list: D004113:Succimer
keywords: DMSA; Encephalopathy; Lead; Moonshine; Succimer