13.

Schuttmann C, Schuttmann W (Inst. Of Occup Med, Berlin-Lichtenberg). The medical prevention of occupational lead poisoning by oral administration of calciumdinatrium ethylenediaminetetraacetate. Zeitschrift fur Arztliche Fortbildung. 1963; 57:1301-1307 (Dec.). (2621) [Treatment of Pb intoxication with chelates such as EDTA is discussed. The mechanism of the chelating reaction is described. Due to the high affinity of Ca to the EDTA salts, it is essential to use an EDTA salt that I saturated in Ca, so that the chelate cannot combine with Ca in the blood. In the German Democratic Republic a CaNa2EDTA called "Weiss" (made by Weiss and Co.) is available, which is administered by infusion or iv injection at a level of 1 g. twice daily for 3 days. This treatment is repeated 2 to 4 times with intervals of 2-3 days. The possibility exists that the chelates combine also with Fe and trace metals such as Zn, Cu, and Mn. The literature reporting an increased excretion of these metals during treatment of Pb poisonings with Cna2EDTA is cited. Another possible side-reaction mentioned by some authors is the development of toxic necrotic nephroses which, however, are generally caused by excessive doses of the chelate. The author never encountered this reaction but advises that the renal function be checked before and during treatment with EDTA and that a daily dose of 2 g not be exceeded. Since orally given CaNa2EDTA is partly resorbed, iv treatment may be followed up with oral administration of 3 g EDTA daily in tablets to insure a consistent flow of Pb elimination.
Prophylactic treatment of Pb intoxications by oral administration of CaNa2EDTA is suggested. Such pharmacologic prophylaxis is opposed by Kehoe, Johnstone, Skinner and others, because it may lead to reduced efforts of industrial preventive measures. As Kehoe points out, it may even conceal poor industrial hygiene. The literature referring to the prophylactic use of EDTA is cited. The authors report that they introduced in a battery plant the prophylactic use of oral CaNa2EDTA. The plant previously had a high rate of Pb poisoning; at some work places the air was found to contain 100 times the maximum allowable Pb concentration of 0.15 mg/cm3. A selected group of 138 workers with high Pb exposure was divided into 2 groups, 1 of which was given 2 g CaNa2EDTA daily for 1 wk of each mo, for a period of 1 yr. No manifest Pb intoxication occurred in the treated group while 5 cases with acute symptoms of Pb poisoning occurred among the controls. These results led to the introduction of prophylactic treatment of all Pb-exposed workers and since then no new cases of Pb poisoning were observed. Twelve spot checks of the Fe level in the serum gave values of >100 mg%.
Situations which call for prophylactic treatment with EDTA are discussed. A distinction should be made between routine prophylaxis and preventive treatment of pre-saturnism (characterized by a Hb content of <75 mg%, stippled cells of >3/1000 erythrocytes, increased porphyrinuria). The latter is treated with 3 g EDTA daily for 7-10 days and possibly a 2nd course after an interval of several days. In some cases a change of the work place may be advisable.]

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