Risk factors for adverse effects during chelation therapy:
(1) unfamiliarity with chelation therapy
(2) failure to consult an expert prior to starting therapy
(3) breakdown in communication (between the physician and pharmacy, other)
(4) using chelation therapy when risk exceeds benefit (chelation therapy is unnecessary for low lead levels)
(5) use of an inappropriate chelation agent
(6) error in dosage
(7) error in route of administration
(8) failure to monitor patient adequately during therapy, including monitoring of calcium and other electrolytes
Agents used for chelation therapy:
(1) edetate disodium calcium (CaNa2EDTA)
(2) dimercaperol (British anti-Lewisite)
(3) D-penicillamine
(4) succimer (meso-2,3-dimercaptosuccinic acid)
Problems arise if edetate sodium (Na4-EDTA) is used, since this may cause fatal hypocalcemia.
