APRIL 7,2008

Goals:

1.Learn and demonstrate safe, sterile technique technique for handling needles,
specimens, blood and related fluids.
•
• 2.Learn and demonstrate appropriate technique and professionalism when
administering venipuncture to a patient.
•
• 3.Learn and demonstrate safe use of all equipment required for a two tube
venipuncture specimen collection.
•
• 4.Learn and demonstrate venous anatomy and site selection for venipuncture.

• 5.Learn and demonstrate muscular anatomy for intramuscular injections.

•
• 6.Learn and demonstrate safe, sterile technique for preparation and filling a
syringe using both cobalamin and folic acid and delivery of an intramuscular
injection/shot of both
7.Learn and demonstrate professionalism when preparing and administering an
IM injection.

Wilson’s disease – too much copper autosomal recessive hepatolenticular

degenerative disease
Brown rings in the iris, similar mental picture as psychophrenia (treatment differences
are very scarey)
misdiagnosis them as – psychophrenia
squestere copper in the liver and brain
HAIR Minearl anylsis is not a heavy metal COpper

D-Penicillamine

Minerals with an Affinity for D-Penicillamine

o Chelates copper.
o Weaker affinity for lead.

Clinical Uses
o Used in Wilson’s disease.

Methods for Clinical Use

o Orally at 500 mg TID or intravenously if the oral dose is not tolerated.
o B6 antagonist.
o Will also chelate zinc.
Cautions and Toxicity Symptoms
o May cause symptoms including: cutaneous lesions, gastrointestinal symptoms,
hypoguesia (loss of taste).
o Risk of allergic sensitivity to D-Penicillamine.

D-Penicillamine (treat HIGH COPPER) could have sulfur increase

- lower the copper take more zinc (kelate copper) 50 mg ZINC citrate/picolinate
(USA)
- used to pull out copper
- ORAL administration
metabolism: to disulfides and other compounds with serum albumin and cysteine
adverse effects: cutaneous lesions, acute sensitivity reactions GI upset Hypoguesia
anatonistic to B6 (25 mg to avoid)
1 protocol is 500 mg tid for 3 mos another protocol: d-pencilliamine in morning zinc
in the evening

Trientine (Trien-2HCl)
Patients who develop reactions to D=Pencilliamine

Minerals with and Affinity for Trientine

o Chelates copper.

Clinical Uses
o Wilson’s disease for patients who cannot tolerate D-Penecillamine.

Methods for Clinical Use

o Monitor iron and zinc levels.
o Administered orally, excreted in the urine.

Cautions and Toxicity Symptoms

o Can cause sensitivity reactions and impair iron absorption.
Trientine (triethylenetetramine) no sulfur molecule increased urinary output due to
nitrogen
Excrete by urine
Metabolism?
Used less commonly
Adverse effects: sensitivity reactions impairs iron absorption
Excretion increased of copper and zinc
Developed by walsh (both from above)

Ditiocarb Sodium

Minerals with an Affinity for Ditocarb Sodium

o Affinity for cadmium (Cd)
 o Increased zinc loss as well
o Inhaled cd is better absorbed than injesting it

Clinical Uses
o Industrial accidents with cadmium.

Methods for Clinical Use

o Given IV and excreted in the urine and bile.
o Half life is 5 minutes.

Cautions and Toxicity Symptoms

o May cause mylosuppression (bone marrow suppression) and gastric ulcers.
o Long term use has been associated with peripheral neuropathy.
o Batteries, smoking, dental prostectics, yellow paint, polish for silver, pesticides,
black rubber back on carpets, tires, plastic tape, black polyethylmene, all get
exposure
o Fatigue, hypertension, iron def anemia, emphysema, anosimia, reduced birth
weight, interferes with vit d absorption, mimics carcinogen (estrogen)
Ditiocarb Sodium (sodium diethyldithiocarbamate)
IV administration double sulfur in compound metabolism to disulfides and carbon
disulfides
Excretes: Cadmium (cd+2) and zinc

Summary of Toxic and Essential Minerals Chelated by Each Agent

Chlelating agent Toxic ions excreted Essential ions excreted

Deferoxamine Al, Ga Fe3, Zn2, Cu2+
D-penicillamine Pb Cu2+, Zn2+
Succimer (DMSA) Pb, As, Hg, Au (RA px) Cu2+
Dimaval (DMPS) Pb, As, Hg, Au Cu2+
Deferiprone Al, Ga Fe3+, Zn2+, Cu2+
Na2CaEDTA (with mg) Pb Fe, Zn, Cu, Mn (Ca+2)
Na3DTPA Pu plutonim, Am Fe, Zn, Cu, Mn
BAL Pb, As, Hg, Au Cu
Trientine Cu, Zn, Mn
Ditiocarb sodium Cd Cu, Zn, Mn

*bolded ones are the most important/common for each kelator

copper/zinc has to be very aware of because they are lost with kelation (copper is a
source from pipes)

Case Studies
71 year old with memory problems
DMPS test – looked at levels of nutrients (urine levels)
Has fillings/ dental work
Mercury very elevated
Nickel elevated (in stainless steel) it’s an alloid (in fillings as well)
Aluminum high (cooking ware)
Has little arsenic/cadmium

Referred to a dentist to remove fillings

And MD to kelate out the mercury
After a year she had responded to the kelation (8 fillings or so)

Nutritional supplementation as well

NaCl or glutathione
MOST IMPORTANT – selenium to help with the kelation

Need to use a rubber dam and need to do this properly

Released as a gas

IF you have mercury

Citris, hot and releases mercury
And it sits in the brain – which is fatty tissue

Wondering what the increased difference would be a if patients also has redaiation
treatment

EDTA – orally not IV in Ontario

NO DMSA or DPSA – in Ontario by ND’s

Patient 2 –
45 yo female
extensive medical history – factory job all her life
one incident she had gotten formeldyhyde dumped on her
feeling a bit paranoid
neurologic symptoms, memory issues
had fillings as well
DMPS – look at her normal minerals
Low mn – tearing of ligments/joint pain
Low iron – anemic
Low copper
Selenium is low
Sulfur is high
Boron/Iodine/Lithium – low
VERY DEFICIENT – poor diet/absorption
Petit female doesn’t sleep well
High mercury/ tin/bismith/nickel/tin/tungsten/uranium/cadmium/arsenic/antimony she’s
exposed to all these metals

Sent her to someone DMSA – felt really good

As mercury drops these other levels will increase (of cadmium, bismith etc)
Increased fiber and adequate nutrients in diet

Need more sodium and potassium (very very hot in work environment) muscle aches and
pains