Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review.

Q2 Medicine Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI:10.5863/1551-6776-29.5.544
Mahi K Singh, Jason M Kane, Sana J Said
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Abstract

Lead poisoning in children has the potential for devastating neurodevelopmental consequences. There is significant socioeconomic disparity in children with lead poisoning. Specific lead chelation regimens have been approved for children by the US Food and Drug Administration, however in the United States, there has been a recent national shortage of the primary therapy, edetate calcium disodium (CaNa2 EDTA). This case report presents a 23-month-old child with severe symptomatic lead poisoning during a national shortage of CaNa2 EDTA to highlight the need for advocacy regarding critical medication shortages, especially for antidote therapy. The infant's initial blood lead level was 364 mcg/dL and he received a continuous infusion of CaNa2 EDTA (1000 mg/m2/day), as well as dimercaprol (4 mg/kg intramuscularly every 4 hours). The supply of CaNa2 EDTA was exhausted on day 3 of therapy so he was transitioned to enteral succimer monotherapy. Initial parenteral therapy of 72 hours achieved a lead level of 72 mcg/dL; he then completed his enteral course of succimer along with environmental mitigation. However, elevated blood lead levels persisted and he subsequently required 3 more courses of enteral succimer, and he continues to have detectable blood lead levels 2 years after initial presentation. In the face of medication shortages including CaNa2 EDTA, and now also dimercaprol, clinicians must create and study alternative chelation therapy regimens for pediatric lead toxicity. Furthermore, public policy initiatives, including the development of a national supply stockpile of chelation agents, must be created in order to minimize supply chain disruption and ensure adequate and equitable antidote therapy for lead poisoning outbreaks.

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关键药物短缺期间的小儿铅螯合治疗:病例报告和文献综述。
儿童铅中毒有可能对神经发育造成破坏性后果。铅中毒儿童在社会经济方面存在巨大差异。美国食品和药物管理局已经批准了针对儿童的特定铅螯合疗法,但在美国,主要疗法乙二胺四乙酸钙二钠(CaNa2 EDTA)最近出现了全国性短缺。本病例报告介绍了一名 23 个月大的儿童在 CaNa2 EDTA 出现全国性短缺期间出现的严重症状性铅中毒,以突出宣传关键药物短缺,尤其是解毒疗法短缺的必要性。这名婴儿最初的血铅含量为 364 微克/分升,他接受了持续输注 CaNa2 EDTA(1000 毫克/平方米/天)以及二巯基丙醇(4 毫克/千克,肌肉注射,每 4 小时一次)。EDTA CaNa2 的供应在治疗的第 3 天耗尽,因此他被转为接受单一琥珀酰亚胺肠内疗法。最初 72 小时的肠外治疗将铅含量降至 72 微克/分升;随后,他完成了琥珀酰亚胺肠内治疗和环境缓解治疗。然而,血铅水平持续升高,他随后又需要接受 3 个疗程的肠内琥珀酰亚胺治疗,并且在初次就诊 2 年后,他的血铅水平仍可检测到。面对包括 CaNa2 EDTA(乙二胺四乙酸钙)和二巯基丙醇在内的药物短缺问题,临床医生必须创建并研究治疗小儿铅中毒的替代螯合疗法方案。此外,还必须制定公共政策措施,包括建立全国性的螯合剂供应储备,以最大限度地减少供应链中断,确保为铅中毒爆发提供充足、公平的解毒疗法。
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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
期刊最新文献
Ketorolac Dose Ceiling Effect for Pediatric Headache in the Emergency Department. Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review. Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review. Pharmacogenomics in Pediatric Oncology Research and Treatment. Propranolol As a Treatment Option for Chylous Effusions and Chylous Ascites in Fetuses and Neonates: A Systematic Review.
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