Institute for Medical Research and Occupational Health
Abstract
Prikazani su podaci o rezultatima liječenja 19 bolesnika otrovanih olovom s kompleksonom EDTA (Na2Ca EDTA). Bolesnici su liječeni kompleksonom u dozama koje su varirale od 2,4 g pa do 24 g na dan, odnosno od ukupno 6 g pa do cca 150 g. Komplekson se davao u infuziji 5%-glukoze, a ukupna dnevna doza je uvijek dijeljena na dva jednaka dijela: jutarnju i popodnevnu. Izlučivanje olova mokraćom i kretanje nivoa olova u krvi u toku terapije različitim dozama EDTA nije potvrdilo pretpostavku o boljem terapijskom učinku većih doza kompleksona. Sudeći barem po laboratorijskim nalazima, nema potrebe da se EDTA primjenjuje u dnevnim dozama koje su veće od dosad uobičajenih {2,4-4,8 g). Što se· tiče frekvencije doziranja lijeka, dobiveni rezultati govore isto tako u prilog već objavljenim iskustvima, da je najbolje aplicirati EDTA u kurama od 2-3 dana sa stankama od 5-7 dana između pojedinih kura. U saopćenju je obrazložena zbog čega se pokušavala s primjenom velikih doza EDTA i istaknuto je kao značajno stečeno iskustvo·o odsustvu bilo kakvih toksičkih popratnih pojava u toku primijenjene terapije. Pokazalo se čak da i znakovi za postojanje bubrežnih lezija prije početka liječenja - i u uvjetima visokog doziranja lijeka - nisu sami po sebi zapreka da se poduzme liječenje s EDTA.Data are presented on the results of the treatment of 19 lead poisoned patients with the complexing agent EDTA. The preparation Mosatil forte Bayer {Na2Ca EDTA) was used. Daily doses varied from 2.4 to 24 g or from 6 to cca 150 g in total. EDT A was given to all the patients in an infusion of 5% glucose diluted from 0.24 to 2.4 g %, in relation to the amount of each dose. The total daily dose was always divided into two equal parts: a morning and an afternoon dose In the course of therapy, in addition to clinical symptoms, the following factors were analysed: elimination of lead in urine, blood lead level, the count of basophilic stippled cells, and the concentration of coproporphyrin in urine. Special attention was paid to the possible occurrence of nephrotoxic side-effects in connection with the use of complexing agents. With all the doses applied the drug produced a favourable clinical effect by diminishing the symptoms of poisoning. The data obtained on the elimination of lead in urine and the blood lead level are in accord with observations from literature, i. e. that EDT A removes from the body very quickly and that only a small part of the drug is used for the formation of chelates with lead. In view of that there is no need for EDT A to be administered in larger daily doses than those used so far (2.4-4.8 g). As to the administration schedule the results obtained also confirm the reports from literature, viz. that the best way of administering EDTA is a treatment lasting 2-3 days with intervals of 5-7 days between each treatment. The analysis of coproporphyrin in the urine and the number of basophilic stippled cells proved a valuable indicator of the therapeutical effect. The gradual introduction of unusually large doses of EDTA is explained by the favourable experience gained with such large doses in the treatment of a patient with severe lead encephalopathy. Although there is no ground for the need of a larger daily EDTA dose - at least judging by laboratory data on lead elimination and lead blood values - the experience obtained concerning the absence of any toxic side-effects in the course of the applied therapy is of great significance. Moreover, it has been proved that not even the symptoms of the existence of kidney lesions before the beginning of treatment are a contraindication for the administration of EDTA
