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TVP_JUL-AUG2018

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PEER REVIEWED 82 JULY/AUGUST 2018 todaysveterinarypractice.com recommended for recent ingestions. Activated charcoal binds poorly to lead and is not recommended. Radiographs can be obtained to identify potential lead in the gut, but if the particulate matter is very fine, it can be hard to visualize. Enemas can help speed transit time through the gut, as can bulking the diet. Endoscopy or surgery may be required to physically remove large pieces of lead. Magnesium sulfate may help precipitate lead to lead sulfate. Lead sulfate is insoluble and poorly absorbed. A baseline complete blood count and chemistry is recommended, as well as baseline blood lead levels. 5 Chelation is required in animals with neurologic or gastrointestinal signs; it is not recommended in asymptomatic animals. Over time, lead distributes to the bones and becomes inert. Chelators (such as calcium ethylenediaminetetraacetic acid) can pull lead out of bone, thereby increasing blood lead levels, increasing intestinal absorption of lead, and, in some symptomatic animals, causing worsening of clinical signs. When chelation is required in animals with lead in the gastrointestinal tract, dimercaptosuccinic acid (succimer) is the only chelator recommended. 6 Other chelators ( TABLE 2 ) can be used in animals without lead in the gastrointestinal tract. In many cases, the actual amount of lead ingested is minor and no significant clinical signs are expected. If chelation is needed, treatment should continue until clinical signs resolve and blood lead levels are reduced to background levels. REFERENCES 1. The Art and Creative Materials Institute. acmiart.org. Accessed October 2016. 2. ASPCA Animal Poison Control Center ANTOX® unpublished data. 2017. 2. Micromedix Solutions. Truven Health Analytics. micromedexsolutions. com. Accessed April 2017. 3. Stern L. How to be prepared for most toxic exposures in dogs and cats. Todays Vet Pract 2017;7(2):128-132. 4. Abadin H, Llados F. Toxicological Profile for Lead. Washington, DC: Department of Health and Human Services; 1999:19-257. 5. Gwaltney-Brant S. Lead. In: Plumlee KH, ed. Clinical Veterinary Toxicology. St. Louis, MO: Mosby; 2004:204-210. 6. Wismer T. Lead. In: Peterson ME, Talcott PA, eds. Small Animal Toxicology. 3rd ed. St. Louis, MO: Elsevier; 2013:609-615. Charlotte Means Charlotte Means, DVM, MLIS, DABVT, DABT, is Director of Toxicology at the ASPCA Animal Poison Control Center (APCC). She received her DVM and undergraduate degree from Oklahoma State University and a master's degree in library and information science from University of Oklahoma. Dr. Means worked in small animal practice and as a clinical medical librarian before joining the ASPCA APCC. TABLE 2 Lead Chelators: Pros and Cons CHELATOR PROS CONS Calcium EDTA Efficient Nephrotoxic Painful injections Chelates essential minerals Dimercaprol Removes lead from brain Nephrotoxic Painful injections Penicillamine Oral Vomiting Nephrotoxic Chelates essential minerals DMSA (succimer) Oral (administer rectally if animal is vomiting) Does not chelate essential minerals Can use with lead in gastrointestinal tract Expensive DMSA, dimercaptosuccinic acid; EDTA, ethylenediaminetetraacetic acid.

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