Which medications in the drug class Chelators are used in the treatment of Smoke Inhalation Injury?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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No reports exist as to the efficacy of chelating agents; however, dimercaprol and edetate calcium disodium (CaEDTA) have been suggested because of their ability to reduce serum zinc levels. Zinc toxicity may be treated with a combination of dimercaprol and CaEDTA or with EDTA alone. Nausea, vomiting, and elevated liver enzymes occur more commonly with combination therapy.

Dimercaprol (BAL in Oil)

Dimercaprol is the drug of choice for treatment of mercury toxicity; although not formally indicated for zinc toxicity, its use has been suggested in the setting of severe zinc oxide inhalation injury, since it lowers serum zinc levels. It is administered by deep intramuscular injection.

Edetate calcium disodium

Although edetate calcium disodium is used mostly in lead chelation, for which it is a second-line agent, treatment with this agent has been associated with lowering of serum zinc levels. Begin therapy 4 h after giving dimercaprol. The IV route is used exclusively, and continuous infusion is recommended.

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