에데트산 칼슘 이나트륨

해독제 / 중금속 킬레이트제

에데트산 칼슘 이나트륨(CaEDTA)은 수의학에서 주로 **납** 및 **아연** 중독 치료에 사용되는 중금속 킬레이트제입니다. 소동물의 납 중독 치료에는 경구 투여가 가능하고 신독성이 낮은 숙시머(DMSA)가 점점 더 선호되고 있지만, 대동물 및 조류에서는 여전히 중요한 주사용 해독제입니다. > **중요한 임상적 주의사항:** 반드시 **칼슘 이나트륨(Calcium Disodium)** 형태의 EDTA를 사용해야 합니다. 칼슘이 없는 에데트산 이나트륨(Na2EDTA)을 투여하면 환자의 내인성 혈청 칼슘을 강력하게 킬레이트하여 빠르고 치명적인 저칼슘혈증을 유발할 수 있습니다. CaEDTA는 수용성이 매우 높고 신장 배설에 크게 의존하므로 치료 중 적절한 수분 공급과 신장 기능 모니터링이 필수적입니다.

작용 기전: CaEDTA works via **competitive chelation**. The calcium ion in the CaEDTA complex has a lower binding affinity than heavy metals. When introduced into the bloodstream, divalent or trivalent heavy metals (such as Pb2+ or Zn2+) displace the calcium: **CaEDTA + Pb2+ → PbEDTA + Ca2+** The resulting heavy metal-EDTA complex is highly stable, water-soluble, and is rapidly excreted by the kidneys into the urine. * Theoretically, 1 gram of CaEDTA binds 620 mg of lead, but in vivo, only about 5 mg of lead is excreted per gram of drug. * It effectively chelates lead and zinc, and to a lesser extent cadmium, copper, iron, and manganese. * It is **ineffective** for mercury, gold, or arsenic poisoning.

동물 종별 용량

Birds

Lead poisoning (Psittacines) · 35 mg/kg IM twice daily for 5-7 days. · IM · q12h · 5-7 days · After initial therapy, may give orally until all lead fragments are dissolved and/or passed from GI tract.
Lead poisoning (Raptors/Falcons) · 100 mg/kg q12h for 5-25 consecutive days. (25% CaEDTA given undiluted IM) · IM · q12h · 5-25 days · Treated if blood lead was >65 micrograms/dL for 5 day courses, until blood lead was <20 micrograms/dL.
Lead or zinc poisoning · 30-35 mg/kg IM q12h x 3-5 days, off 3-5 days, may repeat and/or use another chelator. · IM · q12h · 3-5 days · Maintain hydration. Do not give orally. Can be used IV short term (48 hrs) at 20-35 mg/kg diluted in saline.

Horses

Lead poisoning · 75 mg/kg IV slowly in D5W or saline daily for 4-5 days (may divide daily dose into 2-3 administrations per day). · IV · q24h or divided q8-12h · 4-5 days · Stop therapy for 2 days and repeat for another 4-5 days. Give adequate supportive and nutritional therapy.

Dogs

Lead poisoning · 100 mg/kg SC divided into 4 daily doses in 5% dextrose for 5 days. May require second course of treatment, particularly if blood lead levels >0.10 ppm. Do not exceed 2 g/day and do not treat for more than 5 consecutive days. · SC · divided q6h · 5 days · Be sure there is no lead in GI tract before using.
Lead poisoning · 25 mg/kg SC four times daily for 5 days. Give as 1% solution in D5W. · SC · q6h · 5 days · Provide a 5-7 day rest period between courses of treatment to minimize potential for nephrotoxicity.

투여 경로

SCIMIV

금기

Patients with anuria
Oral (PO) administration in the presence of lead in the GI tract (enhances absorption)

이상반응

Renal toxicity (renal tubular necrosis)
Depression (dogs)
Vomiting
Diarrhea
Zinc deficiency (with chronic therapy)
Pain at IM injection site

약물 상호작용

Glucocorticoids · May enhance the renal toxicity of CaEDTA
Insulin (NPH, PZI) · Concurrent administration will decrease the sustained action of the insulin preparation due to zinc chelation
Nephrotoxic drugs (e.g., aminoglycosides, amphotericin B) · Increased risk of nephrotoxicity; use with extreme caution

모니터링

Blood lead or zinc levels (serial monitoring)
Urine d-ALA
Renal function tests (BUN, Creatinine)
Urinalyses (monitor for casts/glucose indicating tubular damage)
Hydration status
Serum phosphorus and calcium values
Periodic cardiac rate/rhythm monitoring

과용량

Doses greater than 12 g/kg are lethal in dogs. Acute toxicity primarily manifests as severe **renal tubular necrosis**. It can also cause profound depression, vomiting, and diarrhea. Treatment of overdose is largely supportive, focusing on maintaining diuresis and managing uremia.

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