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Lead intoxication after administration of house specialities


, : Lead intoxication after administration of house specialities. Schweizerische Medizinische Wochenschrift 123(46): 2198-2210

Three cases of lead intoxication after the administration of "house specialties" are illustrated. The lead source could be traced to a lead-containing ointment in all three patients. Two of them suffered lead intoxication as a result of topical application to the lips, while the third had ingested the ointment orally. Clinical signs, diagnosis and therapy of lead poisoning are described in the light of the case reports. The patients were treated with various drugs (N-acetylcysteine and the complex chelators D-penicillamine and 2.3-dimercaptocuccinic acid (2.3-DMSA). The therapeutic effects were determined on specific laboratory features in blood and urine. N-acetylcysteine was not absolutely confirming in our case. D-penicillamine was effective, but only after removal of the source of exposure. Because of its known adverse drug reactions, we preferred the oral lead chelator 2.3-DMSA. Treatment with DMSA resulted in a considerable decrease in the blood lead concentration and in increase in urinary lead output. The urinary excretion of aminolevulinic acid and coproporphyrin normalized under DMSA. The treatment was well tolerated and no appreciable side effects were noticed. The literature on metabolism and the characteristic effects of lead intoxication is reviewed and the production, qualities and administration of emplastrum plumbi are described. All three lead-containing ointments are summarized by the characterizing term "house specialties". One wonders whether it is justified that there is still control and registration of such "house specialties" in Switzerland.

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