Course Content Page 8
Chelation Therapy
Chelation therapy is not a substitute for environmental remediation of lead. Chelation therapy is medication that is capable of binding or chelating lead so as to deplete the soft and hard skeletal tissues of lead, excrete the ions of lead through the kidneys, and reduce acute toxicity. Chelation therapy is recommended for children with confirmed blood lead levels of 45 µg/dL or greater. While chelation therapy is considered a mainstay in the medical management of children with BLLs of 45 µg/d and above, it should be used with caution. Children who receive chelation and then return to the same lead contaminated environment are at risk for re-exposure to lead.
Chelation therapy is not recommended for blood lead levels below 45 µg/dl. Children with BLLs < 45 µg/dl should be provided with lead education, frequent follow-up tests for lead, and provided with an environmental risk assessment.
Chelation therapy lowers blood lead and mobilizes skeletal lead. Four chelating agents are currently available: CaNa 2 EDTA, BAL, D-penicillamine, and succimer.
D-penicillamine is not an FDA-approved drug for lead chelation therapy, and if administered, should be done with extreme caution.
Chelating agents enhance urinary excretion of lead but also pose a serious risk to the patient for depleting other essential metals including calcium, magnesium, iron, and zinc. Chelation side effects may include elevated transaminase enzyme levels, gastrointestinal upset, headaches, hypersensitivity reactions, renal damage, transient neutropenia and mild conjunctivitis (14).