April 7

APRIL 7,2008 Goals: 1.Learn and demonstrate safe, sterile technique technique for handling needles, specimens, blood and related fluids. • • • • • • • • •

2.Learn and demonstrate appropriate technique and professionalism when administering venipuncture to a patient. 3.Learn and demonstrate safe use of all equipment required for a two tube venipuncture specimen collection. 4.Learn and demonstrate venous anatomy and site selection for venipuncture. 5.Learn and demonstrate muscular anatomy for intramuscular injections. 6.Learn and demonstrate safe, sterile technique for preparation and filling a syringe using both cobalamin and folic acid and delivery of an intramuscular injection/shot of both 7.Learn and demonstrate professionalism when preparing and administering an IM injection. Wilson’s disease – too much copper autosomal recessive hepatolenticular degenerative disease Brown rings in the iris, similar mental picture as psychophrenia (treatment differences are very scarey) misdiagnosis them as – psychophrenia squestere copper in the liver and brain HAIR Minearl anylsis is not a heavy metal COpper

D-Penicillamine Minerals with an Affinity for D-Penicillamine o Chelates copper. o Weaker affinity for lead. Clinical Uses o Used in Wilson’s disease. Methods for Clinical Use o Orally at 500 mg TID or intravenously if the oral dose is not tolerated. o B6 antagonist. o Will also chelate zinc.

Cautions and Toxicity Symptoms o May cause symptoms including: cutaneous lesions, gastrointestinal symptoms, hypoguesia (loss of taste). o Risk of allergic sensitivity to D-Penicillamine. D-Penicillamine (treat HIGH COPPER) could have sulfur increase - lower the copper take more zinc (kelate copper) 50 mg ZINC citrate/picolinate (USA) - used to pull out copper - ORAL administration metabolism: to disulfides and other compounds with serum albumin and cysteine adverse effects: cutaneous lesions, acute sensitivity reactions GI upset Hypoguesia anatonistic to B6 (25 mg to avoid) 1 protocol is 500 mg tid for 3 mos another protocol: d-pencilliamine in morning zinc in the evening Trientine (Trien-2HCl) Patients who develop reactions to D=Pencilliamine Minerals with and Affinity for Trientine o Chelates copper. Clinical Uses o Wilson’s disease for patients who cannot tolerate D-Penecillamine. Methods for Clinical Use o Monitor iron and zinc levels. o Administered orally, excreted in the urine. Cautions and Toxicity Symptoms o Can cause sensitivity reactions and impair iron absorption. Trientine (triethylenetetramine) no sulfur molecule increased urinary output due to nitrogen Excrete by urine Metabolism? Used less commonly Adverse effects: sensitivity reactions impairs iron absorption Excretion increased of copper and zinc Developed by walsh (both from above)

Ditiocarb Sodium Minerals with an Affinity for Ditocarb Sodium o Affinity for cadmium (Cd)

o Increased zinc loss as well o Inhaled cd is better absorbed than injesting it Clinical Uses o Industrial accidents with cadmium. Methods for Clinical Use o Given IV and excreted in the urine and bile. o Half life is 5 minutes. Cautions and Toxicity Symptoms o May cause mylosuppression (bone marrow suppression) and gastric ulcers. o Long term use has been associated with peripheral neuropathy. o Batteries, smoking, dental prostectics, yellow paint, polish for silver, pesticides, black rubber back on carpets, tires, plastic tape, black polyethylmene, all get exposure o Fatigue, hypertension, iron def anemia, emphysema, anosimia, reduced birth weight, interferes with vit d absorption, mimics carcinogen (estrogen) Ditiocarb Sodium (sodium diethyldithiocarbamate) IV administration double sulfur in compound metabolism to disulfides and carbon disulfides Excretes: Cadmium (cd+2) and zinc Summary of Toxic and Essential Minerals Chelated by Each Agent Chlelating agent Deferoxamine D-penicillamine Succimer (DMSA) Dimaval (DMPS) Deferiprone Na2CaEDTA (with mg) Na3DTPA BAL Trientine Ditiocarb sodium

Toxic ions excreted Al, Ga Pb Pb, As, Hg, Au (RA px) Pb, As, Hg, Au Al, Ga Pb Pu plutonim, Am Pb, As, Hg, Au Cd

Essential ions excreted Fe3, Zn2, Cu2+ Cu2+, Zn2+ Cu2+ Cu2+ Fe3+, Zn2+, Cu2+ Fe, Zn, Cu, Mn (Ca+2) Fe, Zn, Cu, Mn Cu Cu, Zn, Mn Cu, Zn, Mn

*bolded ones are the most important/common for each kelator copper/zinc has to be very aware of because they are lost with kelation (copper is a source from pipes) Case Studies 71 year old with memory problems

DMPS test – looked at levels of nutrients (urine levels) Has fillings/ dental work Mercury very elevated Nickel elevated (in stainless steel) it’s an alloid (in fillings as well) Aluminum high (cooking ware) Has little arsenic/cadmium Referred to a dentist to remove fillings And MD to kelate out the mercury After a year she had responded to the kelation (8 fillings or so) Nutritional supplementation as well NaCl or glutathione MOST IMPORTANT – selenium to help with the kelation Need to use a rubber dam and need to do this properly Released as a gas IF you have mercury Citris, hot and releases mercury And it sits in the brain – which is fatty tissue Wondering what the increased difference would be a if patients also has redaiation treatment EDTA – orally not IV in Ontario NO DMSA or DPSA – in Ontario by ND’s Patient 2 – 45 yo female extensive medical history – factory job all her life one incident she had gotten formeldyhyde dumped on her feeling a bit paranoid neurologic symptoms, memory issues had fillings as well DMPS – look at her normal minerals Low mn – tearing of ligments/joint pain Low iron – anemic Low copper Selenium is low Sulfur is high Boron/Iodine/Lithium – low VERY DEFICIENT – poor diet/absorption Petit female doesn’t sleep well

High mercury/ tin/bismith/nickel/tin/tungsten/uranium/cadmium/arsenic/antimony she’s exposed to all these metals Sent her to someone DMSA – felt really good As mercury drops these other levels will increase (of cadmium, bismith etc) Increased fiber and adequate nutrients in diet Need more sodium and potassium (very very hot in work environment) muscle aches and pains