CORRECTION: DMSA therapy and Doses

[Guest guest]

Hi Alon, Chris & All,

 

Susan, please post to VBMA if you judge chelation therapy a suitable topic.

 

I wrote:

> I have not used DMSA, but a Google suggests circa 10mg/kg

> bodyweight/d. See: http://tinyurl.com/555tn

 

NOTE: My bald statement, " circa 10mg/kg bodyweight/d " , was not

accurate. Apologies: I should not have made a simplistic statement like

that. I based it on a brief Google search, without spending sufficient time

reading the small print. See more accurate [but non-expert and

incomplete] comments below.

 

Chris replied:

> I guess ... if we want to use the reference ranges of the lab that does

> the sample, we get to follow the dosage set by the lab. Otherwise, the

> results will be less meaningful.

 

Chris, IMO, the LAB role is to TEST samples and report results,

including the normal reference ranges. Clinicians should ensure that the

lab holds a current International Standard ISO Certificate for EACH

TEST of interest. Few labs hold such certificates. One should avoid

using labs that do NOT hold the relevant Certificates.

 

IMO the role of the LAB does NOT extend to recommending therpeutic

dosages. IMO, that role should rest with clinicians (physicians, or other

qualified therapists) and clinical researchers who have published the

data to support the recommended doses.

 

DMAS dose varies depending on the PURPOSE (diagnosis or therapy)

for which it is used, the ROUTE of administration (oral, rectal or

parenteral), and on the AUTHORITY (reference sources) that one

follows.

 

For example, the most important and most recent Consensus Position

Paper by the AUTISM RESEARCH INSTITUTE

http://autismwebsite.com/ari/dan/treatmentoptionsmercurymetal.pdf

" Treatment Options for Mercury/Metal Toxicity in Autism and Related

Developmental Disabilities: Consensus Position Paper (February 2005)

AUTISM RESEARCH INSTITUTE, 4182 Adams Avenue, San Diego,

CA 92116 www.AutismResearchInstitute.com says [re TESTING

whether or not there is an undesirable mercury load to be stripped]:

 

Oral DMSA (9-dose): Dosage of 10 mg/kg-dose, 3x/day, for 3 days. Just

before administering the last dose, void the bladder, and then collect all

urine for the next 8-10 hours. This test has the advantage that

Bradstreet et al.1 have established a reference range for typical

children, based on a study of 18 typical children vs. 221 children with

autism. Using Doctor’s Data Laboratory, they reported levels of 1.29 +/-

1.54 mcg Hg/g-creatinine, 15.0 +/- 9 mcg Pb/g-creatinine, and 0.46 mcg

Cd/g-creatinine in typical children given DMSA. Children with autism

had, on average, 3x higher levels of Hg excretion. 6

 

Oral DMSA (single dose): Dosage of 20-25 mg/kg-dose, 1x. Void

bladder and then administer DMSA, and collect all urine for 6-10 hours.

(Do not use only 10 mg/kg, as a study by Adams et al. found no major

difference between 15 children with autism vs. 15 controls). Some

physicians do not recommend this higher single dose due to concerns

about adverse reactions, and prefer the series of lower doses

mentioned previously.

 

Rectal DMSA (single dose): 25mg/kg of body weight as a single bolus

dose with urine collection beginning the next morning in potty trained

children and through the night with pediatric urine collection bags in

those children who aren’t. Collection time varies between 12-24 hours

depending on the physician’s preference and family logistics

 

As regards DMSA THERAPY to strip mercury away after adequate

testing that this is desirable, reference 52 at

http://www.nationalautismassociation.org/pdf/tbinstockcitations.pdf says

that the therapeutic dose was 10mg/kg bodyweight, 3 times/day for 3

days (for one course), with 11 days off before the next course:

 

Ref 52: " A. Holmes, S. Cave, and J.M. El-Dahr. OPEN TRIAL OF

CHELATION WITH MES0-2,3- DIMERCAPTO SUCCINIC ACID

(DMSA) AND LIPOIC ACID (LA) IN CHILDREN WITH AUTISM. As

submitted to IMFAR, June 2, 2001. “Over 400 patients with autism are

currently undergoing treatment for removal of heavy metals. Patients

are treated with DMSA alone at doses of 10 mg/kg/dose 3 times a day

for 3 days in a row (shorter duration than lead protocol to decrease side

effects) with 11 days " off " to allow metals to re-equilibrate. After at least

2 rounds of DMSA alone, the thiol antioxidant lipoic acid (hypothesized

to aide in removal of heavy metals across the BBB) is added to each

dose of DMSA at 2-3mg/kg/dose. In general, noticeable improvements

in language, self-help skills, interaction, and core autistic features are

not seen until the patient has been on DMSA with LA for 2-3 months. "

 

In summary, chelation therapy using DMSA is a most valuable way to

strip undesired or toxic trace-metals from the body BUT it carries some

risks. Therefore, DMSA therapy should be monitored carefully and

communication between patient, guardians, DMSA therapist and the

family physician should be open and total.

 

Best regards,

 

 

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