3. Introduction
80 metals in periodic table
They have corrosive & astringent properties
Act as a protoplasmic poison by inhibiting essential enzymes
Exert toxic effects by combining with and inactivating
functional groups of enzyme like SH,NH2,OH
4. Heavy metal poisoning is not uncommon
Commonly implicated metals
Lead
Mercury
Arsenic
Cadmium
5. Chelation (Chele- Claw)
Process of an equilibrium reaction between a metal ion and
a complexing agent that produce a stable, nonionized, non
toxic & water soluble complexes which can be eliminated easily.
Chelating agents
Agents having ability to form complexes with heavy metal and
prevent or reverse the binding of metallic cation to ligands of the
body
6. Ideal Chelating Agents
More affinity for metals than endogenous ligand
High solubility in water
Resistance to biotransformation
Form non toxic complexes with toxic metal
Accelerate mobilization and/or removal of the metals
Cheap and easy to administer
Easy excretion of chelating complex
8. Dimercaprol(BAL) (2-3 DIMERCAPTOPROPANOL)
Synthesized by Stocken and Thompson during world war II
Developed as antidote to lewisite( arsenical war gas)
BAL-British anti lewisite
Oily, Pungent smelling, Viscous liquid
9. M.O.A
Form poorly dissociable complex with metal ions
Protect the SH enzymes
Prevent inhibition of enzyme
Reactivates the inhibiting enzymes( amount and duration)
P/K
Can’t be given orally
Given by deep IM injection
Short t1/2,Peak plasma level in 1/2hrs -1 hr( IM)
Metabolized in 6hrs and excreted as glucuronide
10. Uses
Poisoning by As,Hg,Pb(AML)
Dose 5mg/kg stat, followed by 2-3 mg/kg every 4-8hrs for
2 days and then twice daily for 10 days
As an adjuvant to edetate in Lead poisoning
As an adjuvant to penicillamine in Wilson’s disease
C/I
Hepatic disease
Iron and cadmium poisoning
11. A/E
Injection is painful and Chances of sterile abscess
Allergic reaction
Nausea, vomiting, headache
Lacrimation,Conjuctivitis,Blepharospasm
Sialorrhoea,paresthesia,muscle pain
Hemolysis in G-6PD deficiency
Anginal pain, Tachycardia, Hypertension
12. DMSA(2,3 Dimercaptosuccinic acid or Succimer)
Synthesized 1940’s by British chemist L.N. Owen
Water soluble analogue of dimercaprol
P/K
Orally administered
Absorption rapid but variable
Rapid and extensive hepatic metabolism
90% cysteine disulfides, 10% unchanged
13. Uses
Lead poisoning
As, Cd, , Hg
Side Effects
GI - nausea, anorexia, vomiting, diarrhea
Weakness, dizziness, rash
Transient elevation of hepatic transaminase enzymes
18. Trientene
Cupriuretic agent
Useful in wilson’s disease
Less potent but safer then d-penicillamine
A/E
Anemia
Dose 2gm in adult in 2-4 divided doses
19. Desferioxamine
Obtained from streptomyces pilocus
Chelator of iron
Removes iron from hemosiderin and ferritin but not from
hemoglobin and cytochrome
M.O.A
Bind ferric iron to form ferrioxamine ( stable , water soluble)
P/K
Poorly absorbed after oral administration ,Used parenterally
Metabolized by enzyme present in plasma
20. Uses
Acute Iron toxicity
10-15mg/kg/hr constant infusion
50mg/kg IM
For chronic iron intoxication
( 0.5 to 1gm/day, IM)
For chelation of aluminum in dialysis patient
22. Deferiprone
Orally effective but less effective then desferrioxamine
Use
In patient in whom desferioxamine is C .I , unacceptable
or not tolerated.
A/E
Anorexia,Vomiting,Joint pain, Blood dyscrasia
Dose 50-100mg/kg daily in 2-4 divided doses
23. Defrasirox
Orally effective
Use
Use when desferrioxamine is C I
Iron over load
A/E
GI ulceration
Fanconi like syndrome
Dose 20-30mg/kg
24. EDTA(Ethylene Diamine Tetra Acetic acid)
EDTA,Calcium EDTA,Edetate calcium disodium
Chelates divalent or trivalent metals
Chelates extracellular metal ions more than intracellular
ions
P/K
Not absorbed orally
Doesn’t cross BBB
IM injection-Painful
25. T/U
Lead poisoning
Acute poisoning
Slow iv , 40mg /kg in two divided doses /day for 5days
Fe,Zn,Cu,Mn, Cd, poisoning
Porphyria
Not useful for Hg poisoning
27. Dicobalt EDTA
Used in cyanide poisoning
Diagnosis must be correct
Cobalt toxicity
28. Chelating agent Use in poisoning
Ca Na EDTA Lead
Desferioxamine Iron,Aluminium
Deferiprone Iron
Dicobalt EDTA Cyanide
Dimercarpol(BAL) Arsenic,Mercury,Lead,Cu,Au
Succimer Cu,Hg,Pb
D-Penicillamine Cu