Calcium Carbonate for Elemental Lead Ingestions: Effect of Alkalinization on Elemental Lead Solubility in a Simulated Ga
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ORIGINAL ARTICLE
Calcium Carbonate for Elemental Lead Ingestions: Effect of Alkalinization on Elemental Lead Solubility in a Simulated Gastric Environment Kartik R. Shah 1
&
Michael S. Runyon 2 & Michael C. Beuhler 3
Received: 18 May 2020 / Revised: 31 August 2020 / Accepted: 1 September 2020 # American College of Medical Toxicology 2020
Abstract Introduction Acute ingestion of elemental lead foreign bodies has resulted in multiple pediatric deaths. Elemental lead is relatively insoluble at alkaline pH. Furthermore, calcium decreases lead absorption by interfering with the lead absorptive receptor. We hypothesize that alkalinization of gastric fluid with an oral calcium-containing agent, such as calcium carbonate, will decrease lead solubility, thus reducing the potential for systemic lead absorption and toxicity. Methods This was an in vitro controlled study. One lead sphere (00 buckshot, cast 30 days prior) was randomly placed in each of ten tubes containing 20 mL simulated gastric fluid, with five tubes having 500 mg calcium carbonate added at 20 min and 140 min. We measured the fluid pH and the lead concentrations hourly for 4 h. We compared the median amount of total lead liberated after 4 h between the two groups using the Mann-Whitney U test. Results The pH of the gastric fluid only tubes remained 1 at every measurement, and the pH of the gastric fluid + calcium carbonate tubes was 6 at every measurement. At hour 4, the total amount of lead liberated in the soluble fraction in the control group vs the calcium carbonate group was 850 vs 12.4 mcg (95% CI for absolute difference: 605–964 mcg; p = 0.0079). Conclusions Calcium carbonate antacid alkalinizes gastric fluid pH and dramatically decreases the total amount of solubilized lead by 60-fold. This project lends foundational evidence to a low-cost, widely available, pre-hospital strategy to decrease lead absorption after acute elemental lead ingestions. Keywords Calcium carbonate . Lead . Alkalinization . Foreign body These data were presented at the 18th Annual Scientific Meeting of the American College of Medical Toxicology (ACMT) March 13-15, 2020 in New York, NY, USA. Supervising Editor: Mark B. Mycyk, MD Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13181-020-00811-6) contains supplementary material, which is available to authorized users. * Kartik R. Shah [email protected] 1
Division of Medical Toxicology, Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Medical Education Building 3rd Floor, 1000 Blythe Blvd, Charlotte, NC 28203, USA
2
Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Medical Education Building 3rd Floor, 1000 Blythe Blvd, Charlotte, NC 28203, USA
3
Division of Medical Toxicology, Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, North Carolina Poison Control, 4400 Golf Acres Drive, Suite B-2, Charlotte, NC 28203, USA
Introduction Lead remains one of the most common pediatric environmental
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