We read with interest the letter from Dr Devlin et al. concerning cobalt (Co) chelation
in prosthetic hip-associated Co toxicity.
1
Currently, chelation in prosthetic hip-associated Co toxicity has been described
in only a few cases with chelating agents such as edetate calcium disodium,
2
sodium 2,3-dimercaptopropane sulfonate, and dimercaprol.
3
Currently, the role of different chelating agents, timing of administration, and
chelating efficacy represent debated aspects in Co chelation. As reported by Dr Devlin,
in the medical literature N-acetyl-cysteine (NAC) has been described as an effective
chelator only in animal models of Co poisoning.
1
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References
- Chelation in suspected prosthetic hip-associated cobalt toxicity.Can J Cardiol. 2013; 29: 1533.e7
- Loss of sight and sound. Could it be the hip?.Lancet. 2009; 373: 1052
- Hip pain and heart failure: the missing link.Can J Cardiol. 2013; 29: 639
- Reversible nephrotoxic reactions to a combined 2,3-dimercapto-1-propanol and calcium disodium ethylenediaminetetraacetic acid regimen in asymptomatic children with elevated blood lead levels.Pediatrics. 1982; 70: 259-262
Article info
Publication history
Published online: December 19, 2013
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© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Chelation in Suspected Prosthetic Hip-Associated Cobalt ToxicityCanadian Journal of CardiologyVol. 29Issue 11
- PreviewWe read with interest the documented fatality from suspected cobalt-induced cardiomyopathy in the case report, “Hip Pain and Heart Failure: The Missing Link” by Dr Gilbert and his associates, in the May 2013 issue of the Canadian Journal of Cardiology. We were intrigued by the authors' use of dimercaprol (BAL) for cobalt chelation in this patient. Little is known about BAL's role in suspected prosthetic hip-associated cobalt toxicity. BAL is generally used in acute arsenic, lead, and mercury poisonings although there is concern that BAL's lipid solubility might increase metal ion flux into the brain.
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