Conclusions and Guidelines for Future Research

In the treatment of metal poisonings general supportive therapy is of utmost importance, focusing on the maintenance of respiration, circulation, water and electrolyte balance, and support of organ function. Elimination of the absorbed poison can be facilitated by forced diuresis, hemodialysis, or exchange transfusion. Chelation therapy is indicated in the treatment of metal poisonings, metal storage diseases, and to aid the elimination of some radionuclides. Dimercaprol (BAL), the classical chelator, is rather outdated today due to its high toxicity. Less toxic analogs dimercapto-propane sulfonate (DMPS) and dimercaptosuccinic acid (DMSA) are used in the treatment of acute and chronic intoxication by inorganic and organic mercury, bismuth, arsenic, and lead. DMSA is the preferred antidote for lead poisoning, for example, in children. Trientine and D-penicillamine have proven to be effective in the treatment of copper accumulation and in the management of Wilson's disease. Deferoxamine (DFO) given parenterally is the treatment of choice in acute iron poisoning. In the treatment of transfusional siderosis, oral treatment with deferiprone and/or deferasirox mobilizes intracellular iron from liver and heart. Derivatives of diethylenetriamine pentaacetate (DTPA) in the form of aerosol have been administered to decrease the lung deposits of inhaled plutonium. Guidelines for future research are discussed in the present chapter.