succimer and Vomiting

Although the incidence of lead toxicosis in small animals continues to decrease, it remains a significant malady. We have reviewed the literature of the past 45 years, which revealed 70 cases involving cats. Sources, signs, diagnosis, pathology and treatment of feline lead toxicosis are reviewed. In 84% of these cases the source of lead was old paint usually from home renovation. The most common signs in cats are anorexia, vomiting, and seizures. The younger individuals seem more likely to show CNS signs. Since signs are often vague, lead toxicosis may be significantly under diagnosed in cats. The gold standard of diagnostic tests is blood lead concentration, although it does not necessarily correlate with total body burden of lead or with metabolic effects including clinical signs. Diagnostic tests including erythropoietic protoporphyrin (EPP), urine aminolevulinic acid, and others are discussed. Gross findings on necropsy are few and include a yellow-brown discoloration of the liver often with a nutmeg-like appearance. Histological examination may reveal pathognomonic inclusion bodies in liver and renal tissues. Characteristic histological changes in the CNS include neuronal necrosis and demyelination. Treatment of lead toxicosis in cats, as in any species, involves removing the exposure, decontaminating the individual and the environment, supportive care and chelation therapy. The most recently available chelator is succimer (meso 2,3-dimercaptosuccinic acid). Succimer given orally is well tolerated and has a wide margin of safety. A high index of suspicion of lead toxicosis is warranted in cats since they often present with vague and non-specific signs. With any consistent history owners need to be asked about home renovation. Early diagnosis and treatment affords a good prognosis.

Topics: Animals; Anorexia; Cat Diseases; Cathartics; Cats; Chelating Agents; Lead Poisoning; Seizures; Succimer; Vomiting

Topics: Adult; Arsenic; Arsenic Poisoning; Chelation Therapy; Diagnosis, Differential; Diarrhea; Fresh Water; Hallucinations; Hepatitis; Humans; Hypotension; Male; Northern Territory; Pancytopenia; Sensation Disorders; Succimer; Vomiting; Water Pollutants, Chemical

Monosodium methanearsonate (MSMA) is an organo-arsenic containing herbicide. There is scant information available concerning the toxicity of this chemical in humans.. Seven male teenagers, 15-18 years of age, inadvertently used a MSMA herbicide as cooking oil to fry fish. All had early gastrointestinal (GI) symptoms. Whole blood arsenic concentrations ranged from 348 to 613 μg/L and initial urine levels ranged from 81 400 to 226 300 μg-arsenic/g-creatinine. They were all treated with dimercaprol for 1 day and succimer for 19 days. They were followed for 15-months and had no evidence of any serious toxicity.. MSMA produces early GI symptoms and very high levels of arsenic in blood and urine, but no evidence of long-term toxicity.

Topics: Accidents, Home; Adolescent; Antidotes; Arsenic Poisoning; Arsenicals; Chelating Agents; Cooking; Dimercaprol; Gastrointestinal Diseases; Herbicides; Humans; Male; Nausea; Succimer; Treatment Outcome; Vomiting

Arsenic trioxide is available for home use in ant baits. Potential arsenic toxicity from unintentional pediatric ingestion is not well studied. The goal of this study is to describe the clinical course and urinary arsenic concentrations of children who ingested ant bait containing arsenic trioxide (0.46%).. This is a case series of pre-school children who unintentionally ingested arsenic trioxide ant bait gel bars in the home reported to two U.S. poison control centers from January 2003 to July 2007.. Six children (age range, 8 months to 4 years) ingested varying portions of ant bait gel bars containing arsenic trioxide (0.46%). All vomited shortly after exposure. The initial, pre-chelation urine total arsenic concentrations ranged from 1,858 to 13,981 mcg/L. All children had resolution of symptoms and received chelation with succimer. Follow-up urine arsenic concentrations were in the normal range 14-35 days after chelation and no further clinical toxicity was noted.. Children who ingest all or part of a household ant bait gel bar that contains relatively low concentration of arsenic trioxide can develop markedly elevated urine arsenic concentrations with minor initial symptoms. Prompt chelation with succimer is recommended for children with these exposures and continued until urine arsenic concentrations are normal.

Topics: Administration, Oral; Arsenic Trioxide; Arsenicals; Chelating Agents; Child, Preschool; Female; Household Products; Humans; Infant; Insecticides; Male; Oxides; Poison Control Centers; Poisoning; Succimer; Vomiting

Two cats from a single household were examined because of neurologic abnormalities suggestive of central vestibular disease. The owner had been renovating her 150-year-old house for the preceding 3 months, and renovations included chipping and sanding of old paint from windowsills and stair railings. Lead toxicosis was diagnosed on the basis of history and concentrations of lead in blood and urine. Both cats were treated with succimer. Treatment was not associated with any adverse effects, and both cats recovered completely. Ingestion of old paint from house renovations is the most common source of lead exposure in cats. Owners of cats with gastrointestinal tract or neurologic abnormalities should be questioned specifically about house renovations.

Topics: Animals; Anorexia; Cat Diseases; Cats; Chelating Agents; Female; Kidney; Lead; Lead Poisoning; Liver; Seizures; Succimer; Tissue Distribution; Vomiting

To compare the response to dimercaptopropanol (BAL) and calcium disodium ethylenediaminetetraacetic acid (EDTA) versus orally administered meso-2,3-dimercaptosuccinic acid (DMSA) and EDTA in children with lead poisoning.. Retrospective review of medical records of children admitted to MetroHealth Medical Center with a whole blood lead (BPb) concentration of 2.17 mumol/L (45 micrograms/dl) or more (or less than 2.17 mumol/L and not a candidate for outpatient oral chelation) and treated with BAL + EDTA or DMSA + EDTA. In each group, the mean BPb values at the end of therapy and at 14 and 33 days after chelation were compared with pretreatment BPb by the Wilcoxon signed-rank test, whereas the Mann-Whitney U test was used to compare percentage change from pretreatment at each follow-up day between the two groups.. Twenty-three children received BAL + EDTA and 22 received DMSA + EDTA. The BPb values (mean +/- SD) at the end of therapy and at 14 and 33 days after chelation were significantly lower than pretreatment in both groups (BAL + EDTA: 17 +/- 10, 34 +/- 7, 36 +/- 11 vs 58 +/- 14 micrograms/dl, p < 0.02, 0.01, 0.001, respectively; DMSA + EDTA: 10 +/- 4, 30 +/- 10, 30 +/- 14 vs 50 +/- 10 micrograms/dl, p < 0.01, 0.001, 0.01, respectively). The percentage reduction (mean +/- SD) in BPb from pretreatment at the end of therapy and on days 14 and 33 after chelation did not differ between the groups (BAL + EDTA: -71.2% +/- 19.8%, -40.2% +/- 13.8%, -37.1% +/- 17%; DMSA + EDTA: -79.9% +/- 8.7%, -38.3% +/- 21.6%, -37% +/- 32%; p > 0.20). Elevation of alanine aminotransferase and vomiting during therapy were observed more frequently in the BAL + EDTA group compared with the DMSA + EDTA group.. Treatment with DMSA or BAL combined with EDTA results in a comparable reduction in BPb.

Topics: Alanine Transaminase; Blood Urea Nitrogen; Child; Child, Preschool; Creatinine; Edetic Acid; Female; Hemoglobins; Humans; Lead Poisoning; Male; Retrospective Studies; Succimer; Vomiting