2/28/12 1 CHELATION: PUBLIC HEALTH CONCERNS Carl Herbrandson, PhD Minnesota Department of Health Minnesota Department of Health St. Paul, MN Our Mission: Protecting, Maintaining, and Improving the Health of all Minnesotans Environmental Health at MDH - Touching Everyone’s Life Every Day - 2 This presentation has not been reviewed or approved by the Minnesota Department of Health.
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PUBLIC HEALTH CONCERNS - ACMT€¦ · PUBLIC HEALTH CONCERNS Carl Herbrandson, PhD Minnesota Department of Health Minnesota Department of Health St. Paul, MN Our Mission: Protecting,
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CHELATION: PUBLIC HEALTH CONCERNS Carl Herbrandson, PhD Minnesota Department of Health
Minnesota Department of Health St. Paul, MN
Our Mission: Protecting, Maintaining, and Improving the Health of all
Minnesotans
Environmental Health at MDH - Touching Everyone’s Life Every Day -
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This presentation has not been reviewed or approved by the Minnesota Department of Health.
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Mercury Maze
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Loncraine Broxton & Partners, Ltd. Made In England (1978) escoinfo.com
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Pre-Chelation Checklist Diagnosis
• Extraordinary Exposure • Biomarkers • Symptoms
Benefit – (Removing metal ≠ Improving outcome!) • Availability of effective chelator, treatment delay, seriousness of symptoms,...
• Relief from symptoms • Longterm prognosis
Risk • Reactivation of stores (target and non-target metals/minerals) • Remove essential metals and minerals
• Shortterm Risk • Subtle and/or latent effects
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Chelation: Public Health Concerns • 1 large incident
Primarily historic seedcoat, fish merthiolate , vaccines
mercurochrome paint, flooring
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• Include questions about skin-lightening cream use in patient history.
• Discuss skin-lightening product use with patient. Mercury or other regulated chemicals (including retinoic acid or steroids) may be the active ingredient in these products.
• Conduct standard disease workup. Include inorganic mercury exposure in differential diagnoses...
• For symptomatic patients, please contact the Regional Poison Center at 1-800-222-1222 for consultation with a poison specialist and/or toxicologist.
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• Include questions about skin-lightening cream use in patient history.
• Discuss skin-lightening product use with patient. Mercury or other regulated chemicals (including retinoic acid or steroids) may be the active ingredient in these products.
• Conduct standard disease workup. Include inorganic mercury exposure in differential diagnoses...
• For symptomatic patients, please contact the Regional Poison Center at 1-800-222-1222 for consultation with a poison specialist and/or toxicologist.
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• Be suspicious. The safest course of action is to discontinue use of all skin-lightening products not used at the direction of a dermatologist.
• Most patients will require no testing; the most effective treatment is discontinuation of use.
• Severe mercury poisoning can be treated with chelation after careful assessment of risk/benefit. Chelation treatment of asymptomatic or mildly symptomatic patients is unlikely to benefit patients, and may actually be harmful.
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Chelation Conundrums • Patients want a single, clear explanation for symptoms
o In all but a few extraordinary instances exposures are too small to result in any symptoms – incorrect diagnosis.
• Patients want treatment o There is a difference between successfully removing a toxin and
having a positive health outcome – questionable efficacy.
• Subtle and latent effects of chelation are not understood o There are health risks from the treatment (the drug, mineral
replacement) and from potential reactivation of stores (targeted metal or other metals).
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Would you chelate? • 7 year old child with acrodynia • Mercury exposure (chronic) found and removed • BP 130/100 (controlled w/medication to 100/65) • Other symptoms resolving
• 2 DMSA treatments in 2 months • 5 months following exposure removal (3 mos post-DMSA)
– BP 98/57
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Caller information • 55 year old male – memory loss, depression
• “toxic” for mercury, selenium, lead and thallium