Bal - Dimercaprol

Figure 12-7. Proposed sites of inhibition (0) of the respiratory chain by specific drugs, chemicals, and antibiotics. The sites that appear to support phosphorylation are indicated. BAL, dimercaprol. TTFA, an Fe-chelating agent. Complex I, NADHiubiquinone oxidoreductase complex II, succinate ubiquinone oxidoreductase complex III, ubiquinohferricytochrome c oxidoreductase complex IV, ferrocytochrome ctoxygen oxidoreductase. Other abbreviations as in Figure 12-4.

Treatment—Patients should be decontaminated immediately prior to treatment using the decontamination method presented in Section 7.3.2. British Anti-Lewisite (BAL) dimercaprol antidote will alleviate some effects. It is available as a solution in oil for intramuscular administration to counteract systemic effects. It is not manufactured currently in the forms of skin and eye ointments.2... 

Examples of this mechanism of action include the administration of BAL (Dimercaprol) for the treatment of arsenic, copper, lead, or mercury intoxication. BAL is usually administered in a does of 3-5 mg/kg intramuscularly every 4 hours for 2 days, then every 4-6 hours for an additional 2 days, then every 4-12 hours for... 

Eyes should be flushed with copious amounts of tepid water for at least 15 min. If 5% BAL (dimercaprol, British Anti-Lewisite) ophthalmic ointment can be applied within 2 min this may prevent a significant reaction. Application up to 30 min after exposure will lessen the ocular reaction but will not prevent all damage (Goldfrank et al, 2002). 

Lewisite Shock Pulmonary injury Blisters Decontamination soap, water, no bleach Antidote BAL-dimercaprol may decrease systemic effects of lewisite Pulmonary management BAL 3-5 mg/kg deep IM q4 h X 4 doses (dose depends on severity of exposure and symptoms) Skin management BAL ointment Eye management BAL ophthalmic ointment... 

Glucose 6-phosphate dehydrogenase deficiency (G-6-PD) Aspirin, BAL (dimercaprol), chloroquine, chloramphenicol, dapsone hydroxychloroquine, nalidixic acid, nitrofurantoin, primaquine, probenecid, quinine, quinidine, sulfonamides Hemolytic anemia... 

Medical personnel should follow the same principles for managing Lewisite skin, eye, and airway lesions that they follow for managing mustard lesions. A specific antidote, BAL (dimercaprol), will prevent or greatly decrease the severity of skin and eye lesions if applied topically within minutes after the exposure and decontamination (however, preparations of BAL for use in the eyes and on the skin are no longer available). Given intramuscularly, BAL will reduce the severity of systemic effects. BAL binds to the arsenic of... 

B. Specific drugs and antidotes. BAL (dimercaprol see p 413) and penicillamine (see p 484) are effective chelating agents and should be used in seriously ill patients with large ingestions. Triethyl tetramine dihydrochloride (Trien or Cuprid) is a specific copper chelator approved for use in Wilson s disease although it is better tolerated than penicillamine, its role in acute ingestion or chronic environmental exposure has not been established. 

Children 1000-1500 mg/m per 24 hours as a continuous IV infusion (diluted to 2-4 mg/mL in nomtal saline or 5% dextrose). Some clinicians advocate that treatment of patients with lead encephalopathy, particularly children, be initiated along with a single dose of BAL (dimercaprol see p 413), followed 4 hours later by the concomitant administration of BAL and calcium EDTA. BAL is discontinued after 3 days EDTA may be continued for up to 5 consecutive days. 

I. Pharmacology. Penicillamine is a derivative of penicillin that has no antimicrobial activity but effectively chelates some heavy metals such as lead, mercury, and copper. It has been used as adjunctive therapy after initial treatment with calcium EDTA (see p 440) or BAL (dimercaprol p 413), although its use has largely been replaced by the oral chelator sucdmer (DMSA, p 501) because of its poor safety profile. Penicillamine is well absorbed orally, and the penicillamine-metal complex is eliminated in the urine. No parenteral form is available. 

Section II Arsenic Arsine Lead Mercury Section III BAL (Dimercaprol) EDTA, Calcium (Calcium Disodium EDTA, Calcium Disodium Edetate, Calcium Disodium Versenate) Succimer (DMSA) Unithiol (DMPS)... 

Four Different Drugs Are Used for Chelation BAL (Dimercaprol)... 

Antidote BAL-dimercaprol may decrease systemic effects of lewisite... 

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