The Biochemical Outcome of two Treatment Protocols in Patients With Opium-associated Lead Poisoning: A Cross-sectional Study in North of Iran
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 11 No. 1 (2021),
23 January 2021
,
Page 32329
https://doi.org/10.32598/ijmtfm.v11i1.32329
Abstract
Background: Lead is a potent toxin that targets heme synthesis and some antioxidant enzymes that induce oxidative stress. Lead exposure remains one of the significant health concerns all over the world. Chelating agents have been used as antidotes for acute and chronic lead poisoning. The present study was conducted to evaluate the biochemical outcome of two different chelating therapies.
Methods: This descriptive cross-sectional study was performed in the Razi University Hospital, Rasht, Guilan. Fifty-six patients with a history of opium use were enrolled in the study who were treated symptomatically. Blood lead Llevels (BLL), Hemoglobin (Hb), Red Blood Cell (RBC), White Blood Cell (WBC), urea, creatinine, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and Alkaline Phosphatase (ALP) were evaluated before and after treatment. The BLL more than 100μg/dl with clinical symptoms was considered as severe lead poisoning (n=34) who received 4 days of DMPS (2,3-dimercaptopropane-1-sulfonate) injection. Other cases with BLL of 20-100μg/dl were considered as those with mild poisoning (n=22) that were treated with oral D-Penicillamine for 14 days.
Results: The mean age of patients was 49.73±14.11 years. Data analysis indicated no significant differences between the groups at baseline regarding the demographic variables. A significant reduction was observed in BLL before and after the intervention using the D-Penicillamine from 75.88±26.22 to 44.3±17.51 μg/dl (P=0.0001). The BLL reduced from 105.5±34.04 to 24.51±24.08 μg/dl after treatment with DMSP (P=0.0001). The levels of ALT, AST, and WBC significantly decreased post-treatment following using D-penicillamine and DMPS (P<0.05). The D-Penicillamine-treated group showed an increase in Hb and RBC (P<0.05).
Conclusion: According to the results, penicillamine improves low to moderate lead toxicity. Although DMSP decreases BLL significantly and reverses liver enzymes, further investigations on Hb and RBC, are needed.
- D-penicillamine
- DMPS
- Opium user
- Lead Poisoning
- Biochemical outcome
How to Cite
References
Rondó PH, Carvalho Mde F, Souza MC, Moraes F. Lead, hemoglobin, zinc protoporphyrin and ferritin concentrations in children. Rev Saúde Publica. 2006; 40(1):71-6. [DOI:10.1590/S0034-89102006000100012] [PMID]
Flora G, Gupta D, Tiwari A. Toxicity of lead: A review with recent updates. Interdiscip Toxicol. 2012; 5(2):47-58. [DOI:10.2478/v10102-012-0009-2] [PMID] [PMCID]
Iran Ministry of Health and Medical Education.Vice-Chancellor in Treatment Affairs. [The protocol to manage patients with LP (Persian)]. 2016. https://vct.iums.ac.ir/uploads/masmoumiat_sorb_mehr_95.pdf
Hoffman R, Howland MA, Lewin N, Nelson L, Goldfrank L. Goldfrank’s toxicologic emergencies. New York: McGraw-Hill Education; 2014. https://books.google.com/books?id=hTcfBQAAQBAJ&q=Goldfrank%27s+Toxicologic+Emergencies,+Tenth+Edition+10th+Edition&dq=Goldfrank%27
Sinicropi MS, Amantea D, Caruso A, Saturnino C. Chemical and biological properties of toxic metals and use of chelating agents for the pharmacological treatment of metal poisoning. Arch Toxicol. 2010; 84(7):501-20. [DOI:10.1007/s00204-010-0544-6] [PMID]
Volans GN, Karalliedde L, Wiseman HM. Review of Succimer for treatment of lead poisoning. Succimer. 2010; 29:1-50. https://www.who.int/selection_medicines/committees/expert/18/applications/succimer.pdf?ua=1
Modell W, Gold H, Cattell M. Clinical uses of 2, 3-dimercaptopropanol (BAL). IV. Pharmacologic observations on BAL by intramuscular injection in man. J Clin Invest. 1946; 25(4):480-7. [DOI:10.1172/JCI101731] [PMID] [PMCID]
Crisponi G, Nurchi VM, Lachowicz JI, Crespo-Alonso M, Zoroddu MA, Peana M. Kill or cure: Misuse of chelation therapy for human diseases. Coord Chem Rev. 2015; 284:278-85. [DOI:10.1016/j.ccr.2014.04.023]
Farallo M, Amoruso C, Frattini C, Ardissino G, Nebbia G. [Nephrotic syndrome after treatment with D-penicillamine in a patient with Wilson’s disease (Italian)]. Pediatr Med Chir. 2012; 34(5):234-6. [PMID] [DOI:10.1172/JCI101731]
Woolf AD, Goldman R, Bellinger DC. Update on the clinical management of childhood lead poisoning. Pediatr Clin North Am. 2007; 54(2):271-94. [DOI:10.1016/j.pcl.2007.01.008] [PMID]
Chandran L, Cataldo R. Lead poisoning: Basics and new developments. Pediatr Rev. 2010; 31(10):399-405. [DOI:10.1542/pir.31-10-399] [PMID]
American Academy of Pediatrics Committee on Environmental Health. Lead exposure in children: Prevention, detection, and management. Paediatrics. 2005; 116(4):1036-46. [DOI:10.1542/peds.2005-1947] [PMID]
Blaurock-Busch E, Busch Y.M. Comparison of chelating agents DMPS, DMSA and EDTA for the diagnosis and treatment of chronic metal exposure. Br J Med Med Res. 2014; 4(9):1821-35. [DOI:10.9734/BJMMR/2014/6875]
Crisponi G, Nurchi VM, Crespo-Alonso M, Toso L. Chelating agents for metal intoxication. Curr Med chem. 2012; 19(17):2794-815. [DOI:10.2174/092986712800609742] [PMID]
Jalali SM, Najafzadeh H, Bahmei S. Protective role of silymarin and D-penicillamine against lead-induced liver toxicity and oxidative stress. Toxicol Ind Health. 2017; 33(6):512-8. [DOI:10.1177/0748233716685660] [PMID]
Kim HC, Jang TW, Chae HJ, Choi WJ, Ha MN, Ye BJ, et al. Evaluation and management of lead exposure. Ann Occup Environ Med. 2015; 27(1):30.[DOI:10.1186/s40557-015-0085-9] [PMID] [PMCID]
Arefi M, Taghadosinejad F, Sadeghniiat-Haghighi K, Salamati P, Godarz F, Saadiyani E. [Effectiveness of Ethylene Diamine Tetra Acetic Acid treatment in patients with lead poisoning referred to Baharloo Hospital, Tehran (Persian)]. J Isfahan Med Sce. 2012; 29(143):773-9. https://www.sid.ir/fa/journal/ViewPaper.aspx?ID=134747
Hayatbakhsh MM, Oghabian Z, Conlon E, Nakhaee S, AmirabadizadehA, Zahedi M, et al. Lead poisoning among opium users in Iran: An emerging health hazard. Subst Abuse Treat, Prev Policy. 2017; 12(1):43. [DOI:10.1186/s13011-017-0127-0] [PMID] [PMCID]
Najari F, Alizadeh Ghamsari A, Vahabzadeh M, Abolbagaei SM, Baradaran Kayal I, Najari D. Evaluation of lead poisoning in opium consumers: In Mashhad, Iran, 2016 evaluation of lead poisoning in opium consumers. Int J Med Toxicol Forensic Med. 2018; 8(2):45-50. [DOI:10.1186/s13011-017-0127-0]
Shadfar F, Zakariaei Z, Ghasempoori SK, Moosazadeh M, Khosravi N. Effect of chelation therapy on leadinduced hepatotoxicity: A case series. Int J Med Toxicol Forensic Med. 2019; 9(3):159-64. [DOI:10.32598/ijmtfm.v9i3.25603]
Ghane T, Zamani N, Hassanian-Moghaddam H, Beyrami A, Noroozi A. Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016-2017. Bull World Health Organ. 2018; 96(3):165-72. [DOI:10.2471/BLT.17.196287] [PMID] [PMCID]
Porru S, Alessio L. The use of chelating agents in occupational lead poisoning. Occup Med. 1996; 46(1):41-8. [DOI:10.1093/occmed/46.1.41] [PMID]
Xu SQ, Li XF, Zhu HY, Liu Y, Fang F, Chen L. Clinical efficacy and safety of chelation treatment with typical penicillamine in cross combination with DMPS repeatedly for Wilson’s disease. J Huazhong Univ Sci Technolog Med Sci. 2013; 33(5):743-7. [DOI:10.1007/s11596-013-1190-z] [PMID]
Cao Y, Skaug MA, Andersen O, Aaseth J. Chelation therapy in intoxications with mercury, lead and copper. J Trace Elem Med Biol. 2015; 31:188-92. [DOI:10.1016/j.jtemb.2014.04.010] [PMID]
Schroder AP, Tilleman JA, Desimone EM. Lead toxicity and chelation therapy. US Pharm. 2015; 40(5):40-4. https://www.uspharmacist.com/article/lead-toxicity-and-chelation-therapy?utm_source=TrendMD&utm_medium=cpc&utm_campaign=US_Pharmacist_TrendMD_0
Kalia K, Flora SJ. Strategies for safe and effective therapeutic measures for chronic arsenic and lead poisoning. J Occup Health. 2005; 47(1):1-21. [DOI:10.1539/joh.47.1] [PMID]
Shabani M, Hadeiy SK, Parhizgar P, Zamani N, Mehrad H, Hassanian-Moghaddam H, et al. Lead poisoning: A neglected potential diagnosis in abdominal pain. BMC Gastroenterol 2020; 20(1):134. [DOI:10.1186/s12876-020-01284-1] [PMID] [PMCID]
- Abstract Viewed: 249 times
- pdf Downloaded: 289 times