Treatment of lead and arsenic poisoning in anuric patients – a case report and narrative review of the literature
Authors
Chun-Yuan Hsiao
Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Private Bag 93311, Otahuhu, Auckland, 1640 New Zealand
Chip Gresham
Department of Emergency Medicine, Middlemore Hospital, Auckland, 1640 New Zealand
Mark Marshall
Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Private Bag 93311, Otahuhu, Auckland, 1640 New Zealand
Keywords:
Arsenic poisoning, Lead poisoning, Chelators, Anuria, Extracorporeal blood purification
Abstract
Heavy metal poisoning can cause debilitating illness if left untreated, and its management in anuric patients poses challenges. Literature with which to guide clinical practice in this area is rather scattered.
Case presentation
We present a case of symptomatic lead and arsenic poisoning from use of Ayurvedic medicine in a 28-year-old man with end-stage kidney disease on chronic hemodialysis. We describe his treatment course with chelating agents and extracorporeal blood purification, and review the relevant literature to provide general guidance.
Conclusion
Cumulative clinical experience assists in identifying preferred chelators and modalities of extracorporeal blood purification when managing such patients. However, a larger body of real-world or clinical trial evidence is necessary to inform evidence-based guidelines for the management of heavy metal poisoning in anuric patients.
Keywords: Arsenic poisoning, Lead poisoning, Chelators, Anuria, Extracorporeal blood purification
Author Biographies
Chip Gresham, Department of Emergency Medicine, Middlemore Hospital, Auckland, 1640 New Zealand
National Poisons Centre, Dunedin, 9054 New Zealand
Mark Marshall, Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Private Bag 93311, Otahuhu, Auckland, 1640 New Zealand
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