디메르카프롤

해독제 / 킬레이트제

디메르카프롤(Dimercaprol, **BAL** 또는 **영국 항루이사이트제**로도 알려짐)은 수의학에서 주로 **비소** 중독 치료에 사용되는 중금속 킬레이트제입니다. 납, 수은, 금 중독에도 간혹 사용됩니다. 제2차 세계대전 중 루이사이트(비소 기반 화학무기)의 해독제로 처음 개발되었으며, 중금속과 결합하여 필수 세포 효소를 방해하는 것을 막는 수لف히드릴기를 포함하고 있습니다. > **임상 요점:** 디메르카프롤은 땅콩 기름에 조제되어 깊은 근육 주사로 투여해야 하며, 상당히 고통스러울 수 있습니다. 셀레늄과 같은 특정 금속에는 비교적 효과가 없으며, 철, 카드뮴, 셀레늄 중독에는 절대 금기입니다(생성된 복합체가 금속 단독보다 더 강한 독성을 띠기 때문입니다).

작용 기전: Heavy metals exert their toxic effects by binding to **sulfhydryl (-SH) groups** on essential cellular enzymes, leading to enzyme inactivation. Dimercaprol contains two sulfhydryl groups that act as "decoys." * **Dimercaprol + Heavy Metal → Heterocyclic Ring Complex** * This complex is more stable than the metal-enzyme bond, allowing the metal to be pulled away from the tissues and excreted via the kidneys and feces. > **Mechanistic Note:** The chelation is not irreversible. The complex can dissociate as dimercaprol concentrations decrease, if oxidized, or in an acidic environment. Therefore, **alkalinizing the urine** is crucial to prevent the complex from dissociating in the kidneys and causing nephrotoxicity.

동물 종별 용량

Cats

Arsenic toxicity · 2.5-5 mg/kg IM · IM · q4h for first 2 days; q8h on 3rd day; BID for next 10 days · Until recovery · Intensive supportive care required. 5 mg/kg dose only for acute cases and only for the first day. Give with sodium thiosulfate.
Arsenic toxicity · 2.5-5 mg/kg IM · IM · q4h for first 2 days, then q12h · Until recovery · If ingestion was within 36 hours. Use emetics/gastric lavage if recent. Institute fluid therapy.
Arsenic toxicity · 4 mg/kg IM · IM · q4-6h · Max 4 continuous days · Do not give for more than 4 continuous days.
Arsenic toxicity · 5 mg/kg IM loading dose, then 2.5 mg/kg IM · IM · q3-4h for two days, then progressively lengthen to q12h · Until recovery · Loading dose of 5 mg/kg for acute cases only.

Cattle

Arsenic toxicity (no clinical signs) · 3 mg/kg IM · IM · q8h
Arsenic toxicity (clinical signs) · 6 mg/kg IM · IM · q8h · 3-5 days
Arsenic, lead or mercury poisoning · 2.5-5 mg/kg IM · IM · q4h · 2 days · Efficacy questionable unless given before signs appear or very early. Withdrawal info not available.
Mercury toxicity · 3 mg/kg IM · IM · four times daily for 3 days, then twice daily · 13 days total · Treatment is often unsuccessful.

Horses

투여 경로

금기

Impaired hepatic function (unless secondary to acute arsenic toxicity)
Iron poisoning
Cadmium poisoning
Selenium poisoning

이상반응

Pain at injection site
Vomiting
Seizures (at higher dosages)
Transient increases in blood pressure
Tachycardia
Nephrotoxicity

약물 상호작용

Iron · Forms a highly toxic complex. Do not administer with iron salts; wait at least 24 hours after the last dimercaprol dose before starting iron therapy.
Selenium · Forms a highly toxic complex. Do not administer with selenium salts; wait at least 24 hours after the last dimercaprol dose before starting selenium therapy. · major
Cadmium · Forms a highly toxic complex. · major
Uranium · Forms a highly toxic complex.
Iron supplements · Forms highly toxic complexes · major

모니터링

Liver function
Renal function
Hemogram
Hydration and perfusion status
Electrolytes and acid/base status
Urinary pH (maintain alkaline pH)

과용량

Clinical signs of dimercaprol overdosage in animals include **vomiting, seizures, tremors, coma, and death**. No specific doses were located to correspond with these clinical signs. Treatment should be supportive and symptomatic.

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