14.

Shiels DO, Thomas DLG, Kearley E. Treatment of lead poisoning by edathamil calcium-disodium. AMA Arch of Ind Health. 1956; 13:489-498 (May). (1718) [Five subjects with industrial Pb poisoning and an 8-yr-old boy with pica-caused Pb poisoning were given CaNa2EDTA orally; the adult dose was 2 g twice a day for several days, followed by omission for ~7 days and then by a 2nd course similar to the 1st. Five were in hospital and watched in detail; the urine was analyzed for Pb and coproporphyrin (CP); blood was examined for Pb content and stippled cell counts. Details of the case histories of these 6 patients are given. (The child's case, presented by McCoy at a meeting, is briefly noted in Medical Journal of Australia 1:662, 1955.) Treatment was also given to 14 ambulatory patients. The drug caused pronounced increase in the concentration of Pb in the urine and in the total daily excretion in the urine. In some cases the increase amounted to 5-35 times for the concentration and to 5-22 time for the total Pb excreted. In some cases this occurred on the 1st day of treatment. Fecal Pb excretion was also increased. As to blood Pb, there was an immediate drop then subsequent rise in some cases; in one case there was a steady fall. These increases continued for several days after cessation of treatment. During the 2nd course of treatment the increases were substantial, but not so excessive. In most instances the amounts excreted in the urine alone greatly exceeded the amount circulating in the blood prior to treatment. In connection with elimination of Pb from body tissues, the authors found it of interest to examine the latter in relation to the amounts present in the body at the start of treatment. On the basis of analyses performed by them and published data, they estimate that in cases of poisoning such as theirs, the amount of Pb in blood and soft tissues might be ~70 mg and ~800-1000 mg in bones. During the course of treatment, 1 patient eliminated a total of 31.5 mg, or ~5 times the amount of Pb in the blood, and ~20 times the amount of Pb which would have been absorbed during the course from food.
The effect on excretion of CP in the urine varied; before treatment the weight of CP excreted exceed 6-fold the weight of Pb excreted; shortly after treatment commenced the weight of CP excreted daily fell to 2/3 of the weight of Pb. The clinical results of treatment were favorable throughout, and a comparison of the effects of Na citrate and EDTA indicated a much greater increase in the excretion of Pb with EDTA than with Na citrate in an equal period of time. The treatment was capable of removing Pb from the bones. The possible metabolic changes which determine the changes observed are discussed.]

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