A 4-year-old child with blood lead level of 75 micrograms/dL presents with vomiting, ataxia, seizures and papilloedema consistent with lead encephalopathy. Along with supportive care, the MOST appropriate chelation regimen is:

• A Calcium disodium EDTA alone as first agent
• B Deferoxamine alone
• C Penicillamine alone
• D Dimercaprol followed by calcium disodium EDTA ✓

Explanation

In paediatric lead encephalopathy, dimercaprol (BAL) is given first to redistribute lead and protect the brain, followed by calcium disodium EDTA to promote urinary excretion, since starting EDTA alone can transiently raise brain lead levels. Deferoxamine chelates iron, penicillamine is reserved for mild cases and copper overload, and EDTA monotherapy is avoided initially in encephalopathic children.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.