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April 25, 1990

Treatment of Lead Poisoning-Reply

Author Affiliations

University of California, San Francisco

University of California, San Francisco

JAMA. 1990;263(16):2182. doi:10.1001/jama.1990.03440160043033

In Reply.—  As indicated in the original article, the details of the therapeutic and diagnostic chelation presented represented one approach to chelation and the approach that we use at the University of California, San Francisco. Unfortunately, controlled and prospective studies that have evaluated various treatment protocols are lacking. Until such studies are done, there will be no single approach to chelation.The edetate disodium calcium leadmobilization test is a measure of total body burden of lead and is used in situations where symptoms of lead toxic reactions are more pronounced than would be expected based on the blood lead level. This situation may occur when blood lead levels are in the approximate range of 1.45 to 3.40 μmol/L, levels that correspond to higher 24-hour urine lead levels than presented in Dr Nadig's hypothetical example. Dr Nadig is correct in stating that doubling of very low 24-hour urine lead levels should

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