Medscape is available in 5 Language Editions – Choose your Edition here.


Pediatric Lead Toxicity Medication

  • Author: Mohamed K Badawy, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
Updated: Jun 22, 2016

Medication Summary

In patients with lead toxicity, the use of chelating agents is recommended for blood lead levels (BLLs) of 45 μg/dL or higher. Chelation can be started with oral succimer, or, if the patient is hospitalized, calcium disodium edetate (calcium EDTA) can be used. These agents have potential toxicities, and monitoring of the complete blood cell count, electrolytes, and liver function test results is necessary.


Chelating Agents

Class Summary

Chelating agents are the criterion standard for the treatment of patients with lead poisoning according to the blood lead levels (BLLs) discussed above. These agents bind to lead and promote its excretion. Patients receiving chelation therapy must be closely monitored because of the agents' potential toxicities.

Dimercaprol (BAL in oil)


Dimercaprol was first developed as an antidote for lewisite toxicity. It is water soluble and rapidly crosses the blood-brain barrier. Dimercaprol forms a nonpolar compound with lead that is excreted in bile and urine. It is the drug of choice in patients with acute lead encephalopathy, in whom the first dose is given and then the second dose is given combined with calcium EDTA after a 4-hour interval.

Edetate calcium disodium (Calcium Disodium Versenate)


This agent decreases blood lead concentration, reverses the hematologic effects of lead, and enhances the excretion of lead in urine.

Succimer (Chemet)


Dimercaptosuccinic acid (DMSA) is a water-soluble analog of dimercaprol. It causes a rapid decline in lead level and replenishes many of the sulfhydryl-dependent enzymes. In the absence of encephalopathy, patients may be treated with DMSA.

D-penicillamine (Cuprimine, Depen)


D-penicillamine is also known as D-dimethyl cysteine. It offers an alternative for oral treatment of lead poisoning. This agent is not approved by the US Food and Drug Administration (FDA) for use in lead poisoning, but has nonetheless been in use for more than 20 years.

Contributor Information and Disclosures

Mohamed K Badawy, MD, FAAP Assistant Professor of Emergency Medicine and Pediatrics, University of Texas Southwestern Medical School; Associate Medical Director, Division of Emergency Medicine, Children's Medical Center Dallas

Mohamed K Badawy, MD, FAAP is a member of the following medical societies: Academic Pediatric Association, Society for Academic Emergency Medicine, American Academy of Pediatrics

Disclosure: Nothing to disclose.


Gregory P Conners, MD, MPH, MBA Director, Division of Emergency and Urgent Care, Children's Mercy Hospital; Vice Chair of Pediatrics for Emergency and Urgent Care; Professor of Pediatrics and Emergency Medicine, University of Missouri-Kansas City School of Medicine

Gregory P Conners, MD, MPH, MBA is a member of the following medical societies: Academic Pediatric Association, American College of Emergency Physicians, American Pediatric Society, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.


Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

  1. Special Report on Lead Poisoning in Children. Public Health Reports. May-June 2005. 120:[Full Text].

  2. Newman N, Jones C, Page E, Ceballos D, Oza A. Investigation of Childhood Lead Poisoning from Parental Take-Home Exposure from an Electronic Scrap Recycling Facility - Ohio, 2012. MMWR Morb Mortal Wkly Rep. 2015 Jul 17. 64 (27):743-5. [Medline]. [Full Text].

  3. Murata K, Iwata T, Dakeishi M, Karita K. Lead Toxicity: Does the Critical Level of Lead Resulting in Adverse Effects Differ between Adults and Children?. J Occup Health. 2008 Nov 6. [Medline].

  4. Centers for Disease Control and Prevention (CDC). Blood lead levels in children aged 1-5 years - United States, 1999-2010. MMWR Morb Mortal Wkly Rep. 2013 Apr 5. 62 (13):245-8. [Medline]. [Full Text].

  5. Canfield RL, Henderson CR Jr, Cory-Slechta DA, et al. Intellectual impairment in children with blood lead concentrations below 10 microg per deciliter. N Engl J Med. 2003 Apr 17. 348(16):1517-26. [Medline].

  6. Koller K, Brown T, Spurgeon A, Levy L. Recent developments in low-level lead exposure and intellectual impairment in children. Environ Health Perspect. 2004 Jun. 112(9):987-94. [Medline].

  7. Richter PA, Bishop EE, Wang J, Kaufmann R. Trends in tobacco smoke exposure and blood lead levels among youths and adults in the United States: the National Health and Nutrition Examination Survey, 1999-2008. Prev Chronic Dis. 2013 Dec 19. 10:E213. [Medline]. [Full Text].

  8. Centers for Disease Control and Prevention. Lead. CDC. Available at February 9, 2015; Accessed: September 4, 2015.

  9. Martínez S, Simonella L, Hansen C, Rivolta S, Cancela L, Virgolini M. Blood lead levels and enzymatic biomarkers of environmental lead exposure in children in Cordoba, Argentina, after the ban of leaded gasoline. Hum Exp Toxicol. 2013 May. 32(5):449-63. [Medline].

  10. Pourmand A, Khedir Al-Tiae T, Mazer-Amirshahi M. Perspective on lead toxicity, a comparison between the United States and Iran. Daru. 2012 Oct 30. 20(1):70. [Medline]. [Full Text].

  11. Lanphear BP, Winter NL, Apetz L, Eberly S, Weitzman M. A randomized trial of the effect of dust control on children's blood lead levels. Pediatrics. 1996 Jul. 98(1):35-40. [Medline].

  12. [Guideline] American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care. AAP. Available at May 2015; Accessed: September 6, 2015.

  13. Lanphear BP, Hornung R, Ho M. Screening housing to prevent lead toxicity in children. Public Health Rep. 2005 May-Jun. 120(3):305-10. [Medline].

  14. American Academy of Pediatrics Committee on Environmental Health. Lead. Handbook of Pediatric Environmental Health. American Academy of Pediatrics. Elk Grove, IL: AAP; 1999. 131-43.

  15. Centers for Disease Control and Prevention. Preventing Lead Poisoning in Young Children. Atlanta: CDC; 2005. [Full Text].

  16. CDC. Screening Young Children for Lead Poisoning. Guidance for State and Local Public Health Officials. Atlanta, GA: United States Department of Health and Human Services; 1997. [Full Text].

  17. Rogan WJ, Dietrich KN, Ware JH, et al. The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Engl J Med. 2001 May 10. 344(19):1421-6. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.