Details About Generic Salt ::  Edetate

Main Medicine Class:: Antidote   

(EH-duh-tate KAL-see-uhm die-SO-dee-uhm)
Calcium Disodium Versenate
Class: Antidote

 

Drugs Class ::

 Action Calcium is displaced by heavy metals, such as lead, to form stable EDTA complexes that are excreted in urine.

Indications for Drugs ::

 Indications Treatment of acute and chronic lead poisoning and lead encephalopathy.

Drug Dose ::

 Route/Dosage

ASYMPTOMATIC ADULTS: IV 5 ml ampule diluted with 250–500 ml normal saline or D5W. Administer dilution over at least 1 hr bid for up to 5 days. Interrupt therapy for 2 days; follow with 5 additional days if needed (maximum 50 mg/kg/day). SYMPTOMATIC ADULTS: IV 5 ml ampule diluted with 250–500 ml normal saline or D5W. Administer dilution over 2 hr. Give second daily infusion at least 6 hr after first. CHILDREN AND PATIENTS WITH OVERT OR INCIPIENT LEAD ENCEPHALOPATHY: IM 35 mg/kg bid q 8–12 hr for 3–5 days; give second course no sooner than 4 days later. Procaine or lidocaine may be added (for concentration of up to 0.5%) to minimize pain on injection.

Contraindication ::

 Contraindications Anuria; active renal disease; hepatitis.

Drug Precautions ::

 Precautions

Pregnancy: Safety not established. Lactation: Undetermined. Hydration: Patients may be dehydrated from vomiting. Because drug is excreted in urine, establish urine flow by IV infusion before administering first dose; then restrict IV fluid to basal water and electrolyte requirements. Lead encephalopathy: Rapid infusion may be lethal in patients with cerebral edema, because of sudden increases in intracranial pressure. IM route is preferred. Renal damage: Discontinue if urinalysis reveals large renal epithelial cells, increasing numbers of red blood cells in urinary sediment or greater proteinuria.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

GU: Renal tubular necrosis.

Drug Mode of Action ::  

 Action Calcium is displaced by heavy metals, such as lead, to form stable EDTA complexes that are excreted in urine.

Drug Interactions ::

 Interactions None well documented.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess renal function prior to and during administration, including frequent urinalysis, BUN and creatinine.
  • Document serum lead level prior to and during administration.
  • Assess hydration status prior to administering drug.
  • Assess for signs of increased intracranial pressure prior to and during IV administration.
  • Obtain baseline and periodic ECG.
  • Hydrate patient with IV infusion prior to administration because patient may be dehydrated from vomiting, and then reduce rate to basal fluid and electrolyte requirements.
  • Maintain strict I&O measurement and daily weights. Do not administer unless patient has adequate urine output. Discontinue drug and notify physician if anuria develops.
  • Monitor vital signs and assess for paresthesia, hypotension, arrhythmias, febrile reactions and histamine-like reaction including flushing, headache, sweating, sneezing, congestion and tachycardia.
  • Wait 1 hr after administering dose before drawing serum lead sample.
  • Notify physician and discontinue drug if urinalysis reveals renal damage, including large epithelial cells, increased protein, RBCs or BUN.
  • Rehydrate in event of anuria and continue drug once urine flow resumes.
  • Discontinue IV administration and notify physician if signs of increased intracranial pressure develop.
  • Obtain ECG if patient complains of palpitations or heart rate irregularities.
OVERDOSAGE: SIGNS & SYMPTOMS
  Cerebral edema, renal tubular necrosis

Drug Storage/Management ::

 Administration/Storage

  • Dilute 5 ml ampule in 250–500 ml of normal saline or D5W for IV administration.
  • Use infusion pump to control rate of infusion. Infuse over at least 1 hr for asymptomatic adults. Infuse over at least 2 hr for symptomatic adults.
  • Administer second daily infusion no sooner than 6 hr after first dose.
  • Administer IM if patient is child or has lead encephalopathy. Inject deep into well-developed muscle, and rotate injection sites. Use procaine or lidocaine to minimize pain at injection site.
  • Administer dimercaprol in separate injection site if used concurrently with edetate calcium disodium.
  • Administer in courses of 3–5 days, with second course given no sooner than 2 days later if given IV or 4 days later if given IM.

Drug Notes ::

 Patient/Family Education

  • Explain method of administration and potential side effects.
  • Instruct patient to notify physician immediately if side effects occur.
  • Explain rationale for strict I&O measurement and how to assist.
  • Refer to public health agency regarding potential sources of lead poisoning and assistance for family in proper removal.
  • Provide appropriate referrals for child who has learning deficits resulting from lead poisoning.
  • Teach signs of lead poisoning, including metallic taste in mouth, abdominal cramping, GI upset, decreased urine output, alteration in mentation, blue-black line along gum, paresthesia, seizures and coma. Instruct to notify physician if any of these signs appear.
  • Counsel family in low-fat diet with adequate calcium, magnesium, zinc, iron and copper to prevent binding and storage of lead in body.
  • Review follow-up schedule of appointments to monitor serum lead levels.

Disclaimer ::

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