Document dYvLgMrmwyKbjkr33GwKnByg0

12033 P Treatment of Lead Poisoning with SodiumCitrate. Seymo ur S. Ket y a x T. V. Let o no f f . (Introduced byJ. HaroldAustin.) From the Biochemical Laboratory, Philadelphia General Hospital. Ininvestigations undertaken byone of us (S.S.K.) it was found that sodium citrate in dilute solution exerts a powerful solvent effect ontertiary leadphosphate.1that citrate removes lead ion from solutionbythe formation of asolublecomplexof extremelylowdis sociation," and that the administration of sodium citrate to lead poisoned rats produced a significant increase in the excretion of lead.1 Thejunior author (T.V.L.) independently observed that in a case of plumbism receiving potassium citrate incidental to a chloride excretion test there was a sharp drop in the blood lead level and a rise in the urinary output of lead. (Chart I. No. 7.) These observations led to the present study of the effects of the administrationof sodiumcitrate inplumbism. Six cases of lead poisoning seen at the Philadelphia General Hospital since August, 1940, provided the basis of this study.* All presented clinical evidence of mild to severe lead intoxication and all had abnormally high lead concentrations in whole blood on ad mission. Each adult received from 2 to 4 g of sodium citrate andthechildren from1to 2gbymouth 3times daily. Blood lead concentrations and, in 3 cases, urinary lead excretions were deter- 1Kety, S. S., read before the Undergraduate Medical Association, Medical School, University of Pennsylvania, April 4, 1940. - Kety, S. S., to be published. . *Theauthors arc indebted to Dr. W. llrody, Dr. E. L. Noone, the late Dr. R, H. Thompson, the late Dr, R. G. Torrey, and Dr. L, A. Wikler onwhose services these patients were treated. N13983 0012268- MG. Pb PER100c.C.WHOLEBLOOD M G.Pb PbRJOOC.C.WHOLEBLOOD IE1.. S(RodeiaudmmitaistiroanteotfhrNoou.gh1ouatf.ter 47 days without treatment.) ,,Sodium c.i.trat.e throughout, calciumcarbonate 14th to 21st day. 3. 4. SSSooodddiiiuuummmccciiitttrrraaattteee,tthihrrrooonuuggahhnooduutct.,opcpalecriuamndgtluWcaomnaintec1h7lothridtoe t2h9rtohudghayo.ut. <bSodium citrate throughout. 7. Potassiumcitrate 2dand 3d days. S. Sodiumcitrate throCuhgahrout t.II--Treatment rece,ived. 1. Disodiumphosphate, cevitamic acid and oleumporcomorphumthroughout. 2. Disodiuni phosphate, diet highinphosphorus andcalcium, viosterol, cevitamic acid34..anOCdlaeltuchimuiammpeilrnaccoctmahtlooerrpiahdnuedmthcrtaholcurioguuhmgohuotp.uhto.sphate throughout, cevitami.c acid 9th to 14thday, cod liver oil 14thto 57th day. 5. No specific treatment. 6. Calciumphosphate 5th to 15th day. 7. Calciumchloride throughout, S9.. D(HiheyaddrmoitsascihonystoefroNlot.h8roaufgtheoru1t.0 months without treatment) Brower s yeast, nicotinic acid and cevitamic acid throughout, monosodiumphosphate and calcium carbonate Gtli to 21st day. minedbefore andat intervals during the course of treatment by the method of i.e.onolf and Reinhoid'1slightly modified.1 The results are presented in Chart I. Ihere was a rapid disap pearance of toxic symptoms without untoward reactions in every instance and the blood lead concentration fell to normal or nearly normal levels, (normal range as determined by this method is from0 to 0.05 mg lead per ICOg of whole blood). Urinary ex cretion studies gave*variable results with a trend toward increased urinary excretion of lead during treatment. In Chart II are pre sLetouoff, T. V., andBeinhold, J. G., Inti. Eng. Chcm., Anal. Eel., 1940, 12, 280. 4LotonofE, T. V., to bepublishedin Ind. Eng. Cheni*, Anal. Ed* K 001226-9 .seinedthe changes inblood lead (determined by the same method) ni pVactioennttrsolvlvdeidthstpuldmynbisisimnprerocegirveisnsgwoitthherotthheerracpiytr.ate compounds to determine the means whereby lead is removed trom the blood Whatever the mechanism of action of sodium citrate, the lapid alleviation of symptoms and the drop in blood lead levels observed shouldmakeit auseful therapeutic agent andapossible prophylactic measure inleadpoisoning. The authors wish to express their gratitude for the guidance of Dr. John G. Reinhold. 'I'er-c nd ca!r - `st' !t Vthv 1disap. even,. docelarlsy ve.\-_ a.sec/ Pi-eiso? I HE 0012270