Veni Notes March 31st

[email protected], [email protected], [email protected], [email protected] VENI Notes March 31st, 2008 EDTA • Not great for Hg toxicity, it doesn’t really bond it well • Mg and Ca have strong bonding affinities, Ca bonds stronger than Mg. • EDTA IV with higher Mg will pull out more Ca from the plaques in the arteries. • Ca EDTA is used to pick up lead from the body. • BR CA pts are given Ni EDTA to try to draw out the Pb, Cu, Hg, Fe and Cr, but the Tx didn’t work as the researchers hoped. • EDTA excreted in urine, T1/2 30-60mins. Accelerates excretion of Pb, Pu (Plutonium), An, Cu, Fe, Mn, Ca • Adverse: hypocalcemia, arrythmias, n/v/d, fever, h/a, urinary urgency, renal damage, allergic reactions uncommon. • Tx: max 2/wk or too much stress on KI. Given via angiocath or butterfly. • EDTA is safe to use in children. Has been used in autism. • Used in kids getting MRIs. •

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DTPA r/t to EDTA. T1/2 30-6-mins. Urine excretion. Pulls out Pu, Am (in ceramics and nuclear reactors). Acccelerates excretion of Fe, Zn, Cu. Adverse common to EDTA but at lower doses. LIHOPO pulls out Pu, Am3. Accelerates Fe3 excretion (supplement and monitor Ferritin). Doesn’t touch Zn. Used to Tx nuclear workers who’ve been exposed. BAL Urinary and biliary excretion, T1/2 1hr. Metab to disulfides, likely binds to serum proteins via disulfide links. Accelerates excretion of: Pb, As (arsenic), Sb (tin), Hg, Au, Cu. Adverse: HTN, tachy, n/v, pain at site, burning in mouth/throat/eyes, lacrimation, hypersalivation, h/a. Glucose-6-phosphate dehydrogenase deficiency may suffer hemolysis after BAL (b/c their cells are larger and more pliable). Same goes for sickle cell, thalassemia, etc. Certain CA types may cause G6P deficiency in the Liver. RA pts using Au therapy may be Tx to remove Au toxicity. Careful, ‘cause they’re more susceptible to KI failure. DMSA Urinary excretion, T1/2 2h after oral administration. Can be given Oral, IM, rectal supp. Has sulfide bonds, will metab to disulfides. Removes Pb, As, Hg, Sb, Bi, Au, Cu. Primary Use is for Au. Crosses BBB!!! Most Hg deposited in brain. Adverse: skin rash, GI discomfort (changing dose will alter this). Unpleasant taste. Allergy/rash possible but not very common. Typically 250mg bid-tid x 3-4 days, then take 10days off and repeat if needed. Most pts will take 5-15 cycles. Test for Hg tox with hair levels.

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Missed some of the adverse reactions…. DMDS Doesn’t cross BBB (animal studies). Used as a challenge test. Pt urinates, draw DMPS (250mg/5ml) in H20, push it, then pt saves urine for 24hr and send to lab for testing. Will look for Pb, Hg, As, Sb, Bi, Au, Cu (slight), Fe (slight). Pts must drink 2-3L of H20. Lab needs 30ml urine for testing. Urine excretion, metab to disulfide bonds. M/c IV as approved by FDA. Deferoxamine Helps with Fe, Al, Ga (Gallium), Zn removal. Tx for pts with hemachromatosis and thalassemia who have Fe overload. S/E: abd discomfort, leg cramps, tachy, ocular toxicity, blurred vision. 25% of kids hearing loss during Tx, (hearing may or may not return). Better not to Tx kids, Tx as adults (unless Tx required). Will affect kids growth, bone/disk/vertebrates, etc. Iron is a growth factor for Yersinia and Rhizopus spp. Deferiprone For pts sensitive to deferoxamine or when Tx with same was not effective in reducing Fe. Sometimes will switch btwn the two for Tx. S/E: nausea, rash, agranulocytosis (generally reversible), antinuclear antibodies (25% of pts), liver damage on long Tx possible. Nutrition Oral Mg and Se may help to remove Al. Oral/IV (likely stronger IV) Vit C is a natural weak chelator, unsure of what it has an affinity for.