Lead Poisoning

Medications

Chelating agents are used for severe lead poisoning. Chelating agents are medicines that bind with lead in blood and both soft and bony tissues and eliminate it quickly from the body, usually through the urine.

The use of chelating agents for lead poisoning is still being studied, and there is no single treatment or drug of choice. In general, drug treatment is recommended when blood lead levels are above 45 micrograms per deciliter (mcg/dL) or when there are symptoms of lead poisoning, especially lead encephalopathy.

Chelation therapy is not recommended for all children with blood lead levels of 20 mcg/dL through 44 mcg/dL.¹⁰ Reducing or removing environmental lead sources, correcting iron deficiency, and improving nutrition may be enough to lower lead levels in the blood. The decision to use chelating agents depends on how long a child has been exposed to lead, the child’s blood lead level, and his or her symptoms. It also depends on whether the blood lead level stays high after the child eats a more balanced diet and after the source of lead is removed or reduced.

In theory, chelating agents prevent further damage by reducing blood lead levels. Damage to the blood may repair itself if blood lead levels are lowered. Kidney damage may also heal, unless it has been too extensive. Chelation therapy may not reverse central nervous system (brain and spinal cord) damage that has already occurred.

Medication Choices

Chelating agents are chemicals that bind with lead for the treatment of lead poisoning.

What To Think About

Chelating agents increase absorption of lead and other metals. A person exposed to lead while taking a chelating agent may absorb more of the lead, thus defeating the purpose of the therapy and possibly doing even more harm. Therefore, it is essential that lead sources be removed from your environment before treatment. (This may require that treatment be administered in a hospital.) Do not return home or to the workplace until lead sources have been removed.

Results need to be reported to the local health department if 2 or more blood lead levels are above 10 mcg/dL. A home inspection is needed to find the source of the lead contamination.

If blood lead levels do not come down with treatment, your home and work areas need to be rechecked for other sources of lead. Contact your local health department to see what inspection services are available in your area.

Iron deficiency also increases lead absorption. Iron deficiency cannot be treated at the same time as chelation therapy because the chelating drug will bind to iron and remove it as well. Iron deficiency must be treated either before or after chelation therapy.

Chelation therapy does reduce blood lead levels and may slow down problems with kidney function associated with lead poisoning. But it does not appear to improve cognitive damage or other neurological problems already caused by the lead poisoning.¹² If chelation therapy is necessary, it is best to consult with a doctor experienced with this treatment.

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Author:	Debby Golonka, MPH	Last Updated: June 26, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics R. Steven Tharratt, MD, MPVM, FACP, FCCP - Pulmonology, Critical Care, Medical Toxicology
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