Dimercaptopropanol BAL

Abbreviations DHG = Ar,Ar-di(2-hydroxyethyl)glycine NTA = nitrilotriacetic acid EDTA = ethylenediaminetetraacetic acid tiron = pyrocatechol-3,5-disulfonic acid BAL = 2,3-dimercaptopropanol unithiol = sodium 2,3-dimercaptopropane sulfonate tren — triaminatriethylamine penten = tetrakis(aminoethyl)ethylenediamine bipy = 2,2 -bipyridyl phen = 1,10-phenanthroline. 

British antilewisite (BAL[2,3-dimercaptopropanol]), dimercaprol DMPS (2,3-dimercapto-l-propanesulfonic acid)... 

Copper toxicity has been observed, althongh it is not a function of dietary overload. Abnormally low levels of ceruloplasmin associated with the genetic disorder, Wilson s disease, lead to excessive deposition of copper in the central nervous system, ocular tissue, liver, and other organs. Severe psychotic symptoms are observed. Urinary excretion of the copper can be achieved with specific chelating agents such as British anti-lewisite (BAL, 2,3-dimercaptopropanol) or penicillamine, orally administered. Symptoms of the disease are reversed as the copper levels return to normal. Reduction of dietary copper nptake by competition with relatively high levels of oral zinc is also effective. ... 

Similar to the mustard agents, exposure prevention is the first line of defense against lewisite. Rapid decontamination is especially relevant to lewisite exposure due to the rapid development of pain (1-2 min) associated with lewisite exposure. Unlike other vesicants, an effective antidote for lewisite toxicity exists in the form of British anti-lewisite (BAL 2,3-dimercaptopropanol) which binds with arsenicals, thereby countering the lewisite-induced damage. Such chelation therapy is associated with notable side effects (e.g. renal effects) and requires carefiil medical management. More effective analogs of BAL have been developed with less significant side effects. 

Syrup of ipecac (purging solution) and gastric lavage should be administered within 4-6 h of oral exposure to arsenic. Antidotes include 3-5 mg kg BAL (2,3-dimercaptopropanol) administered intramuscularly. Penicilamine has also been administered with optical neuritis as a side effect. Certain synthetic, water-soluble dimercapto compounds (DMSA - meso-2, 3-dimercaptosuccinic acid and 2,3-dimercaptopro-pane-l-sulfonate) have been found effective. 

Chelation therapy is usually the treatment of choice. Both CaNai-EDTA (calcium disodium salt of ethylenediaminetetraacetic acid) and British Antilewisite compound (BAL 2,3-dimercaptopropanol) are commonly used to remove lead from the body. Both are administered via intramuscular injection. BAL binds lead to sulfhydral groups and chelates metal from both inside and outside the cellular space. Lead removal through the bile and urine is increased within 30 min of administration. BAL is the common choice when there is known toxicity to the kidney, but it is contraindicated if there is liver failure or glucose-6-phosphate dehydrogenase deficiency. BAL treatment has produced a number of adverse reactions, including nausea, vomiting, tachycardia, and fever. 

Figure 4.1 PMl curves calculated for metal ion-chelating agents bj using computer simulation. PMI is as defined in the text. Ligand symbols Tren — tri-ethylenetetramine EDTA = ethylenediaminetetraacetic acid DTP A = diethylenetriaminepentaacetic acid CDTA = cyclohexylenedijiitrotetra-acetic acid Pen = n-penicillamine OxPen = D-penicillamine-S-S-D-penicillamine, i.e. dimer of Pen BAL = 2,3-dimercaptopropanol DFO = desferrioxamine...

Alloxan apparently also acts by interacting with SH groups and lowering the blood glutathione, since its action is prevented by SH-containing compounds such as glutathione, cysteine, BAL (2,3-dimercaptopropanol) or thioglycolic acid administered immediately before or within a few minutes after injection of alloxan [82, 86, 87]. However, the actual mechanism by which alloxan acts is still rather poorly understood. 

It has been proven that chelators, such as calcium-EDTA or penicillamine, are not efficient [38]. BAL (2,3-dimercaptopropanol-l) can be used to treat rabbits that absorbed high quantities of sodium tungstate but the LD50 does not increase very much (84 mg/kg instead of 71 mg/kg) [20]. Hard-metal pneumoconiosis is generally treated with corticoids, although their real efficiency has not been proven. 

Adler, F.H., Wilfred, E.R, Leopold, I.H., 1947. Pathologic study of ocular lesions due to lewisite (p-chlorovinyldichloroarsine) changes with and without BAL (2,3-dimercaptopropanol) therapy. Arch. Ophthalmol. 38, 89-108. 

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