Pediatric emergency medicine trisk 3124 3124
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TABLE 102.16
GUIDELINES FOR CHELATION THERAPY OF LEAD POISONING
Condition, BLL
Regimen a
Comment
Encephalopathy
BAL 450 mg/m2 /day +
75 mg/m2 IM every 4 hrs for
5 days
Continuous infusion, or 2–4
divided IV doses, for 5
days (start 4 hrs after
BAL)
50–75 mg/m2 every 4 hrs
for 3–5 days (see text)
Continuous infusion, or 2–4
divided IV doses, for 5
days (start 4 hrs after
BAL)
350 mg/m2 TID for 5 days,
then BID for 14 days
CaNa2 EDTA 1,500 mg/m2
/day
Symptomatic,
BAL 300–450 mg/m2 /day
and/or BLL >70
CaNa2 EDTA 1,000–1,500
mg/m2 /day
Asymptomatic,
BLL 45–69
Succimer 700–1,050 mg/m2
/day
or
CaNa2 EDTA, 1,000 mg/m2 Continuous infusion, or 2–4
divided IV doses, for 5
/day
days
a Doses
expressed in mg/kg: BAL 450 mg/m2 (24 mg/kg), 300 mg/m2 (18 mg/kg); CaNa2 EDTA 1,000
mg/m2 (25–50 mg/kg), 1,500 mg/m2 (50–75 mg/kg); Succimer 350 mg/m2 (10 mg/kg).
BLL, blood lead level (mcg/dL); BAL, British Anti-Lewisite; IM, intramuscular; IV, intravenous.
Adapted from American Academy of Pediatrics, Committee on Drugs. Treatment guidelines for lead
exposure in children. Pediatrics 1995;1996:155–160; Henretig FM. Lead. In: Goldfrank LR, Flomenbaum
NE, Lewin NA, et al., eds. Goldfrank’s Toxicologic Emergencies . 9th ed. New York: McGraw-Hill; 2009.
Pesticides
CLINICAL PEARLS
