Shortened forms of provocative lead chelation.

Abstract

Shortened urinary lead collections following provocative chelation have been standardized for pediatric patients, but have not been considered adequate for adults. This study compared shortened urine collections for lead excretion post chelation with standard 24-hour collections. Thirty-five patients without known current lead exposure and with serum creatinine measurements less than 2 mg/dL were hospitalized and had provocative chelation performed as follows: One gram of CaNa2-ethylenediaminetetraacetic acid (EDTA) was administered in 250 mL of a 5% dextrose in water solution intravenously over one hour; the same dose was repeated 12 hours later. A 24-hour urine collection for lead excretion was begun at the time of initiation of the first dose. At three hours and six hours from start of first dose, each patient was instructed to void, total volume to that point was recorded, and a 10-mL aliquot was withdrawn for lead measurement. Both three-hour and six-hour urinary lead excretion following a single dose of EDTA correlated linearly with 24-hour lead excretion post chelation (r = .89 and .94, respectively). When a 24-hour level of 600 micrograms was defined as "true positive" the three-hour collection had a sensitivity of 76% and specificity of 95% and six-hour urinary lead excretion had 82% sensitivity and 100% specificity. Mild renal insufficiency (reflected by serum creatinine levels between 1.5 and 2.1 mg/dL) did not significantly alter the correlation between three-, six-, and 24-hour urinary post-chelation lead excretion.