Table 3.
Suggested known chelators for the clinical management of the THM poisoning.
| Chelator | Mercury (Hg) | Lead (Pb) | Chromium (Cr) | Cadmium (Cd) | Arsenic (As) | Best Route of Administration | Side Effects/Considerations |
|---|---|---|---|---|---|---|---|
| Dimercaprol (BAL) | For acute inorganic Hg/contraindicated for organic Hg/limited efficacy in chronic poisoning | Suggested | Suggested | Cd-BAL complex is much more nephrotoxic than Cd itself | Limited efficacy in chronic poisoning | IM | Injection site pain, nausea, vomiting, fever, kidney toxicity, headache, restlessness, increased blood pressure, tachycardia |
| CaNa2EDTA | Suggested | Suggested | Non-optimal effectiveness | Non-optimal effectiveness | IV | Nausea, vomiting, fever, increased blood pressure, arthralgia, allergic reactions, local inflammation, nephrotoxicity, headache, anorexia, myalgia, fatigue, thirst, chills, cardiac complications | |
| D- penicillamine | For acute inorganic mercury | Significant adverse effects; currently replaced by succimer | Suggested | Ineffective or detrimental | Suggested | PO | Allergic reactions, immunodeficiency, worsening of neurological manifestations in patients with Wilson's disease |
| Succimer (DMSA) | For acute inorganic mercury | FDA-approved | Suggested | Suggested | Suggested: chelator of choice | PO | Nausea, vomiting, diarrhea, fever, hives, dizziness, weakness |
| Unithiol (DMPS) | For acute inorganic mercury | Suggested | Limited efficacy in chronic poisoning | PO, IV | Rash, nausea, leucopenia | ||
| DTPA | Suggested | IV |
IM: intramuscular injection, IV: intravenous injection, PO: oral administration.