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Dimercaprol is a medication used to treat toxic exposure to arsenic, mercury, gold, and lead. It is in the chelating class of drugs. This activity outlines and reviews the indications, actions, and contraindications for dimercaprol as a valuable agent in treating arsenic, mercury, gold, and lead toxicity. This activity will highlight the mechanism of action, adverse event profile, and other key factors such as dosing, pharmacokinetics, and monitoring pertinent for healthcare team members in the treatment of patients with heavy metal toxicity and related conditions. Objectives: Outline the indications for dimercaprol. Identify the mechanism of action of dimercaprol. Describe the adverse effects of dimercaprol. Review interprofessional team strategies for improving care coordination and communication to advance dimercaprol and improve outcomes. Access free multiple choice questions on this topic.

There are no antidotes available for dimercaprol. Therefore, if toxicity presents with dimercaprol, cessation of therapy is recommended until the resolution of symptoms. Clinical judgment should be used to determine whether to continue, taper off, or discontinue treatment with dimercaprol.

Heavy metal toxicity is a serious condition that can cause high morbidity and mortality, and prompt management with chelation therapy is crucial in severe cases. [Level 5] All interprofessional healthcare team members must be aware of the signs and symptoms of acute heavy metal toxicity and the appropriate steps necessary. In suspected or known exposures, the clinician and pharmacist should consult the regional poison control center, and chelating agents such as dimercaprol should be obtained from the facility if not already in supply. Emergency department physicians, nurses, pharmacists, laboratory technologists, and physicians of other specialties must all work together when coordinating a plan of care for the patient. Whole blood concentrations and 24-hour urine concentrations of arsenic, mercury, gold, or lead are necessary for determining the level of toxicity, the dose of the chelating agent, and monitoring therapy. Other labs to assess hepatic and renal function are also important when managing chelation therapy. [Level 4] Throughout their hospital course, the patient should be monitored for signs and symptoms of worsening heavy metal toxicity, adverse effects of dimercaprol or other chelating agents, and the alleviation of symptoms. Nursing can help the team assess the effectiveness of treatment, administer dimercaprol, and report any concerns to the treating clinician. A social worker may also be consulted to assist the patient and family members when dealing with occupational or home exposures. These are only examples of how working as an interprofessional team can significantly impact the morbidity and mortality of heavy metal toxicity and the appropriate use of dimercaprol. [Level 5]