142.

Belknap EL, Perry MC. Treatment of inorganic lead poisoning with edathamil calcium-disodium. AMA Archiv. Ind. Hygiene Occup. Med. 1954; 10:530-547 (Dec.). (1463) [Seven men with heavy Pb absorption were hospitalized and treated with CaNa2EDTA intravenously (iv) in doses of 5 cc or 1 g diluted in 250 cc of 5% dextrose in distilled water twice a day for 5 days followed by a rest period of 2 days, with resumption of the 5-day course, then another period of rest for 2 days, and finally a course of 4 days as before. The total dose of the drug administered varied from 25-30 g. Pb excretion in the urine increased from 5 to 10 to 20 times, with a definite peak of such excretion occurring almost immediately within the first 24-48 hr after the beginning of treatment. There was a sharp reduction of urinary Pb excretion after 2 or 3 days, despite continued treatment. A secondary peak of Pb excretion occurred after 2 or 3 days' rest period. It is therefore suggested that the most effective way to use EDTA is to give it iv for only 2 or 3 days, alternating with a 4- or 5-day rest period, thus reversing the regimen of 5 days' treatment and 2 days' rest used in the authors' patients. Usually the coproporphyrin (CP) excretion in the urine dropped promptly soon after the EDTA treatment was started and remained down. If CP excretion does not drop promptly after the institution of the treatment, it may be that further deleading courses of the drug should be given. Thus, porphyrin in the urine may be used as an index of the effectiveness of EDTA in deleading Pb.
One of the patients resumed his former occupation as an operator of a wastepaper press, the paper worked on having been heavily contaminated with Pb. Reexposure necessitated readmission to the hospital for recurrence of abdominal Pb colic. The patient was given EDTA orally in tablet form, 2 g daily, or a total dose of 16 g. Close observation of the Pb excretion in the urine suggested that possibly oral administration of EDTA is somewhat effective, though to a much less degree than iv administration.
Oral prophylactic treatment is still too experimental to be widely recommended. Treatment with the drug given iv proved to be not only effective but safe, with no real evidence of any untoward results immediate or remote. Iv treatment with the drug does not give the prompt relief of Pb colic that one expects within ½ hr with iv administered Ca gluconate. Therefore, a combination of Ca gluconate iv in alternate doses with iv administered EDTA is calculated to give immediate pain relief, combined with a sharp reduction of circulating, and therefore potentially dangerous, Pb.]

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