Contact Us    Contact Us     |     Feedback
MOBILE VIEW  | 

EDETATE CALCIUM DISODIUM

Export To Excel

Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Edetate calcium disodium is a sterile, injectable chelating agent used for reducing blood levels and depot stores of lead in acute and chronic lead poisoning and lead encephalopathy.

Specific Substances

    1) Calcium disodium edathamil
    2) Calcium disodium edetate
    3) Calcium disodium EDTA
    4) Calcium disodium ethylenediaminetetraacetate
    5) Calcium disodium versenate
    6) Calcium EDTA
    7) Edetate Ca disodium
    8) EDTA, calcium derivative, disodium salt
    9) Sodium calcium edetate
    10) CAS 62-33-9
    1.2.1) MOLECULAR FORMULA
    1) C10-H12-Ca-N2-Na2-O8.xH2O (Prod Info Calcium disodium versenate, 2004)

Available Forms Sources

    A) FORMS
    1) Edetate calcium disodium is a sterile, injectable concentrated solution for intravenous infusion or intramuscular injection. It is available in 5 mL ampules each containing 1000 mg of edetate calcium disodium in water for injection (equivalent to 200 mg/mL) in water for injection (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012).
    B) USES
    1) Edetate calcium disodium is indicated for reducing blood levels and depot stores of lead in acute and chronic lead poisoning and lead encephalopathy in adults and pediatric populations (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) WITH THERAPEUTIC USE
    1) The following adverse effects have been reported with the use of edetate calcium disodium: Inverted T waves and cardiac rhythm irregularities, transient decreases in blood pressure, acute necrosis of the proximal tubules, microscopic hematuria, glycosuria, proteinuria, nephrotoxicity, acute renal failure, dermatitis and exfoliative dermatitis of the scrotum, injection site pain following intramuscular injection, hypocalcemia, hypercalcemia, nausea, vomiting, abdominal pain, diarrhea, mild elevations in SGOT and SGPT, anemia, bone marrow depression, fatigue, myalgia, zinc deficiency, headache, tremors, numbness, and tingling.
    2) In patients with lead encephalopathy, edetate calcium disodium may worsen cerebral edema. For patients with lead encephalopathy, edetate calcium disodium should be begun 4 hours after administration of dimercaprol.
    B) WITH POISONING/EXPOSURE
    1) No ill effects were observed following inadvertent administration of 5 times the recommended dose, infused intravenously over a 24-hour period of time, to an asymptomatic 16-month-old with a blood lead level of 56 mcg/dL
    0.2.3) VITAL SIGNS
    A) WITH THERAPEUTIC USE
    1) A transient decrease in blood pressure, ranging from 5 to 20 mmHg was reported in over half of patients in one study.
    0.2.20) REPRODUCTIVE
    A) There are no adequate well-controlled studies of the use of edetate calcium disodium in pregnant women. Edetate calcium disodium is in pregnancy category B. It is not known if edetate calcium disodium is excreted in human breast milk. A reproduction study in rats at doses up to about 25 to 40 times the human dose revealed evidence of fetal malformations. These teratogenic effects were prevented by simultaneous supplementation of dietary zinc.

Laboratory Monitoring

    A) Monitor renal and hepatic function, serum electrolytes, urinalysis, urine sediment, and ECG. Levels should be checked before each course of therapy and monitored daily during therapy in severe cases and after the second and fifth day of therapy in less serious cases. Monitor blood lead and zinc levels.
    B) Refer to the "Lead" document for additional information.

Treatment Overview

    0.4.6) PARENTERAL EXPOSURE
    A) There is no antidote.
    B) Treatment is symptomatic and supportive.
    C) No ill effects were observed following inadvertent administration of 5 times the recommended dose, infused intravenously over a 24 hour period of time, to an asymptomatic 16-month-old with a blood lead level of 56 mcg/dL.
    D) HYPOTENSION: Infuse 10 to 20 mL/kg isotonic fluid. If hypotension persists, administer dopamine (5 to 20 mcg/kg/min) or norepinephrine (ADULT: begin infusion at 0.5 to 1 mcg/min; CHILD: begin infusion at 0.1 mcg/kg/min); titrate to desired response.
    E) ACUTE OR CHRONIC EXPOSURE
    1) OBTAIN BLOOD LEAD LEVEL - Hospitalize any child with a blood lead level (BLL) of 45-69 micrograms/deciliter (mcg/dL) and symptoms (significant CNS or protracted gastrointestinal symptoms), or with BLL of greater than or equal to 70 mcg/dL, with or without symptoms .
    2) Chelation therapy should be instituted in all patients with a blood lead level of 45 micrograms/deciliter (2.2 micromoles/liter) or greater using venous blood lead measurement. The child should be in a lead-safe environment before beginning chelation therapy . Patients who do not have severe lead poisoning and can tolerate oral agents are generally treated with oral agents (primarily succimer).
    3) CALCIUM EDTA PROVOCATION TEST - Has been used in the past to determine necessity for therapeutic chelation in children with blood lead levels of 25 to 44 mcg/dL. Because of difficulty in administration, expense, and the unreliability as a predictor of total body lead burden, this test is rarely used in clinical practice.
    4) CHELATION THERAPY
    a) Chelation therapy should be instituted in all patients with a blood lead level of 45 micrograms/deciliter (2.2 micromoles/liter) or greater using venous blood lead measurement. If a capillary sample is used and BLL is elevated, a second BLL by venipuncture should be performed before starting chelation therapy. The child should be in a lead-safe environment before beginning chelation therapy. Returning the individual to a contaminated environment may result in re-accumulation of the metal. Symptoms and signs, along with the blood lead level, determine the route, dose, and agent to be used for chelation. Oral agents (primarily succimer) are generally used in patients without severe poisoning or evidence of encephalopathy, who are able to tolerate oral medications.
    b) BAL (dimercaprol) - 3 to 5 mg/kg/dose deep IM every 4 hours for 2 days; then every 4 to 6 hours for 2 more days; then every 4 to 12 hours up to an additional 7 days.
    c) CALCIUM EDTA - for children with lead encephalopathy or lead levels of 70 mcg/dl or higher, dose is 1500 mg/m(2)/day administered as a continuous intravenous infusion starting 4 hours after the administration of dimercaprol. For children without encephalopathy, the dose is 1000 mg/m(2)/day administered as a continuous infusion. Alternatively, it may be administered at a dose of 50 to 75 mg/kg/day deep IM in 3 to 6 divided doses for up to 5 days; however the pain associated with this route of administration make it less desirable. Establish adequate urine output prior to administering calcium EDTA.
    d) SUCCIMER - Initial dose is 10 mg/kg or 350 mg/m(2) orally every 8 hours for 5 days; reduced to every 12 hours for an additional 2 weeks. OSHA prohibits prophylactic chelation therapy in workers occupationally exposed to lead.
    e) D-PENICILLAMINE - 250 mg 4 times a day PO for up to 5 days. Do not exceed 40 mg/kg/day. OSHA prohibits prophylactic chelation therapy in workers occupationally exposed to lead.
    5) ESTABLISH ADEQUATE FLUID BALANCE with a urine flow of 1 to 2 mL/kg/hour, unless encephalopathy present or suspected, or increased intracranial pressure noted on CT. Do not force fluids if neuro compromise possible.
    6) PERFORM A NEUROLOGICAL EXAM with particular reference to the presence of encephalopathy; particularly after starting EDTA, mental status may worsen; observe carefully.
    7) CEREBRAL EDEMA - May be managed by ventilation and the administration of 1.5 g/kg of 20% mannitol IV over 20 minutes. Dexamethasone: up to 1 to 2 mg/kg/day IV in divided doses. Lumbar puncture is dangerous in the presence of increased intracranial pressure.
    8) SEIZURES: Administer a benzodiazepine; DIAZEPAM (ADULT: 5 to 10 mg IV initially; repeat every 5 to 20 minutes as needed. CHILD: 0.1 to 0.5 mg/kg IV over 2 to 5 minutes; up to a maximum of 10 mg/dose. May repeat dose every 5 to 10 minutes as needed) or LORAZEPAM (ADULT: 2 to 4 mg IV initially; repeat every 5 to 10 minutes as needed, if seizures persist. CHILD: 0.05 to 0.1 mg/kg IV over 2 to 5 minutes, up to a maximum of 4 mg/dose; may repeat in 5 to 15 minutes as needed, if seizures continue).
    a) Consider phenobarbital or propofol if seizures recur after diazepam 30 mg (adults) or 10 mg (children greater than 5 years).
    b) Monitor for hypotension, dysrhythmias, respiratory depression, and need for endotracheal intubation. Evaluate for hypoglycemia, electrolyte disturbances, and hypoxia.
    9) FOR ENCEPHALOPATHY, institute BAL followed 4 hours later by EDTA in the maximum dose. Administer EDTA as a continuous infusion over 24 hours.
    10) Although chelation therapy is associated with significant decrease in BLL, surgery may be considered to remove lead foreign bodies.
    11) Refer to the "Lead" document for more information.

Range Of Toxicity

    A) No ill effects were observed following inadvertent administration of 5 times the recommended dose, infused intravenously over a 24 hour period of time, to an asymptomatic 16 month old with a blood lead level of 56 mcg/dL

Clinical Effects

Summary Of Exposure

    A) WITH THERAPEUTIC USE
    1) The following adverse effects have been reported with the use of edetate calcium disodium: Inverted T waves and cardiac rhythm irregularities, transient decreases in blood pressure, acute necrosis of the proximal tubules, microscopic hematuria, glycosuria, proteinuria, nephrotoxicity, acute renal failure, dermatitis and exfoliative dermatitis of the scrotum, injection site pain following intramuscular injection, hypocalcemia, hypercalcemia, nausea, vomiting, abdominal pain, diarrhea, mild elevations in SGOT and SGPT, anemia, bone marrow depression, fatigue, myalgia, zinc deficiency, headache, tremors, numbness, and tingling.
    2) In patients with lead encephalopathy, edetate calcium disodium may worsen cerebral edema. For patients with lead encephalopathy, edetate calcium disodium should be begun 4 hours after administration of dimercaprol.
    B) WITH POISONING/EXPOSURE
    1) No ill effects were observed following inadvertent administration of 5 times the recommended dose, infused intravenously over a 24-hour period of time, to an asymptomatic 16-month-old with a blood lead level of 56 mcg/dL

Vital Signs

    3.3.1) SUMMARY
    A) WITH THERAPEUTIC USE
    1) A transient decrease in blood pressure, ranging from 5 to 20 mmHg was reported in over half of patients in one study.
    3.3.4) BLOOD PRESSURE
    A) WITH THERAPEUTIC USE
    1) A transient decrease in blood pressure, ranging from 5 to 20 mmHg was reported in over half of patients in one study (Seven, 1960).

Heent

    3.4.3) EYES
    A) WITH THERAPEUTIC USE
    1) Lacrimation has been reported, occurring toward the end of the infusion, more commonly at doses of 3 grams/day or more (Seven, 1960).

Cardiovascular

    3.5.2) CLINICAL EFFECTS
    A) ELECTROCARDIOGRAM ABNORMAL
    1) WITH THERAPEUTIC USE
    a) Inverted T waves have been reported (Klaasen, 2001).
    B) CONDUCTION DISORDER OF THE HEART
    1) WITH THERAPEUTIC USE
    a) Cardiac rhythm irregularities have been reported (Prod Info Calcium disodium versenate, 2004).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) CENTRAL NERVOUS SYSTEM FINDING
    1) WITH THERAPEUTIC USE
    a) Reported adverse effects include dose-related fatigue, myalgia, and frontal headache. These reactions occurred after infusions of high doses formerly used to treat patients with Wilson's disease, usually 3 grams or more over a 24-hour period. Initial symptoms of numbness, tingling, yawning, nasal congestion, and prolonged sneezing occurred toward the end of an infusion, and were followed by abrupt onset of fever and chills.
    1) Four to 8 hours after infusion, malaise, fatigue, severe myalgia, periarticular muscle and joint pain, frontal headache, anorexia, nausea, urinary frequency, and thirst were noted. The fever persisted for 12 to 18 hours, with other symptoms subsiding gradually afterwards (Seven, 1960).
    B) TREMOR
    1) WITH THERAPEUTIC USE
    a) Tremors, numbness, tingling, and headache have been reported (Prod Info Calcium disodium versenate, 2004).
    C) INTRACRANIAL PRESSURE
    1) WITH POISONING/EXPOSURE
    a) Following intravenous infusion of edetate calcium disodium, patients with lead encephalopathy and cerebral edema may experience a lethal increase in intracranial pressure. The intramuscular route is the preferred route for these patients. In addition, this agent may aggravate the symptoms of severe lead poisoning (eg; cerebral edema, renal tubular necrosis) (Prod Info Calcium disodium versenate, 2004).

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) NAUSEA, VOMITING AND DIARRHEA
    1) WITH THERAPEUTIC USE
    a) Reported adverse effects included anorexia, nausea, vomiting, abdominal pain and diarrhea (Seven, 1960; Prod Info Calcium disodium versenate, 2004).
    B) CHEILITIS
    1) WITH THERAPEUTIC USE
    a) Cheilosis has been reported (Prod Info Calcium disodium versenate, 2004).
    C) THIRST FINDING
    1) WITH THERAPEUTIC USE
    a) Excessive thirst has been reported (Prod Info Calcium disodium versenate, 2004).

Hepatic

    3.9.2) CLINICAL EFFECTS
    A) LIVER ENZYMES ABNORMAL
    1) WITH THERAPEUTIC USE
    a) Mild elevations in SGOT and SGPT are common. Levels return to normal within 48 hours of cessation of therapy (Prod Info Calcium disodium versenate, 2004).

Genitourinary

    3.10.2) CLINICAL EFFECTS
    A) ACUTE TUBULAR NECROSIS
    1) WITH THERAPEUTIC USE
    a) Acute necrosis of the proximal tubules, which can result in fatal nephrosis, has been reported. Changes in distal tubules and glomeruli have been reported infrequently (Prod Info Calcium disodium versenate, 2004).
    B) BLOOD IN URINE
    1) WITH THERAPEUTIC USE
    a) Microscopic hematuria, glycosuria, proteinuria, and large epithelial cells in urinary sediment have been reported (Prod Info Calcium disodium versenate, 2004).
    C) TOXIC NEPHROPATHY
    1) WITH THERAPEUTIC USE
    a) Nephrotoxicity is the most common adverse effect of edetate calcium disodium. In a study of 130 children receiving chelation therapy for lead intoxication, including edetate calcium disodium 25 mg/kg intramuscularly every 12 hours for 5 days, 16% developed biochemical evidence of nephrotoxicity; 4 children (3%) developed severe, oliguric, acute renal failure.
    1) Transient mild elevation of serum creatinine was the most common finding; mild transient proteinuria and glycosuria were also observed. The effects were reversible in all cases; the onset and duration of serum creatinine elevations were 6 to 7 days and 11 to 22 days, respectively (Moel & Kumar, 1982; Seven, 1960).

Hematologic

    3.13.2) CLINICAL EFFECTS
    A) ANEMIA
    1) WITH THERAPEUTIC USE
    a) Anemia has been reported by the manufacturer. Anemia was also reported in a patient with Wilson's disease treated chronically with a combination of edetate calcium disodium and disodium EDTA. After a total dose of 72 grams had been given, anemia was noted. It resolved after discontinuation of the chelators (Prod Info Calcium disodium versenate, 2004; Seven, 1960).
    B) MYELOSUPPRESSION
    1) WITH THERAPEUTIC USE
    a) Transient bone marrow depression has been reported (Prod Info Calcium disodium versenate, 2004).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) DERMATITIS
    1) WITH THERAPEUTIC USE
    a) Dermatitis has been reported following chronic therapy. The lesions appear initially on the nasal cheek folds as erythematous macular lesions, which become papular and scaling and progress to the corners of the mouth, chin, forehead, trunk or extremities. They resemble vitamin B6 deficiency, but have been reported in patients receiving adequate dietary vitamin supplementation (Seven, 1960).
    b) Exfoliative dermatitis of the scrotum has been reported and responded to vitamin replacement while continuing therapy in 2 cases. The lesions disappear after discontinuation of therapy, usually within 6 days (Seven, 1960).
    B) INJECTION SITE PAIN
    1) WITH THERAPEUTIC USE
    a) Injection site pain has been reported following intramuscular injection (Prod Info Calcium disodium versenate, 2004).

Musculoskeletal

    3.15.2) CLINICAL EFFECTS
    A) MUSCLE PAIN
    1) WITH THERAPEUTIC USE
    a) Severe myalgia and periarticular muscle and joint pain have been reported (Prod Info Calcium disodium versenate, 2004; Seven, 1960).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ACUTE ALLERGIC REACTION
    1) WITH THERAPEUTIC USE
    a) Histamine-like reactions (sneezing, nasal congestion, and lacrimation) and rash have been reported (Prod Info Calcium disodium versenate, 2004).

Reproductive

    3.20.1) SUMMARY
    A) There are no adequate well-controlled studies of the use of edetate calcium disodium in pregnant women. Edetate calcium disodium is in pregnancy category B. It is not known if edetate calcium disodium is excreted in human breast milk. A reproduction study in rats at doses up to about 25 to 40 times the human dose revealed evidence of fetal malformations. These teratogenic effects were prevented by simultaneous supplementation of dietary zinc.
    3.20.2) TERATOGENICITY
    A) LACK OF EFFECT
    1) ANIMAL STUDIES
    a) Oral doses of 1340 mg/kg were not teratogenic in rats (Schardein et al, 1981).
    B) ANIMAL STUDIES
    1) A reproduction study in rats at doses up to about 25 to 40 times the human dose revealed evidence of fetal malformations. These teratogenic effects were prevented by simultaneous supplementation of dietary zinc (Prod Info Calcium disodium versenate, 2004).
    2) Edetate calcium disodium was teratogenic in rats when given in doses comparable to those used in humans. Doses of 4, 6, and 8 mmol/m(2)/day subcutaneously (comparable to human doses of 1500, 2250, and 3000 mg/m(2)/day) resulted in submucous cleft, cleft palate, adactyly-syndactyly, curly tail, and abnormal ribs and vertebrae. These effects were prevented by zinc supplementation (Brownie et al, 1986).
    3.20.3) EFFECTS IN PREGNANCY
    A) PREGNANCY CATEGORY
    1) Edetate calcium disodium is in pregnancy category B (Prod Info Calcium disodium versenate, 2004).
    B) HUMAN
    1) There are no adequate well-controlled studies of the use of edetate calcium disodium in pregnant women. There is no recognized use of edetate calcium disodium during labor and delivery; its effects during these processes are unknown (Prod Info Calcium disodium versenate, 2004).
    2) CASE REPORT - In one case, a woman treated in the eighth month of pregnancy with 75 mg/kg/day for 7 days delivered a normal infant 4 weeks later (Angle & McIntire, 1964).
    C) ANIMAL STUDIES
    1) One study performed in rats at doses up to 13 times the human dose revealed no evidence of harm to the fetus (Prod Info Calcium disodium versenate, 2004).
    3.20.4) EFFECTS DURING BREAST-FEEDING
    A) LACK OF INFORMATION
    1) It is not known if edetate calcium disodium is excreted in human breast milk (Prod Info Calcium disodium versenate, 2004).
    3.20.5) FERTILITY
    A) ANIMAL STUDIES
    1) One study performed in rats at doses up to 13 times the human dose revealed no evidence of impaired fertility or harm to the fetus (Prod Info Calcium disodium versenate, 2004).

Carcinogenicity

    3.21.1) IARC CATEGORY
    A) IARC Carcinogenicity Ratings for CAS62-33-9 (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004):
    1) Not Listed
    3.21.4) ANIMAL STUDIES
    A) LACK OF INFORMATION
    1) Long-term animal studies have not been conducted to evaluate the carcinogenic potential of edetate calcium disodium (Prod Info Calcium disodium versenate, 2004).

Genotoxicity

    A) Long-term animal studies have not been conducted to evaluate the mutagenic potential of edetate calcium disodium (Prod Info Calcium disodium versenate, 2004).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Monitor renal and hepatic function, serum electrolytes, urinalysis, urine sediment, and ECG. Levels should be checked before each course of therapy and monitored daily during therapy in severe cases and after the second and fifth day of therapy in less serious cases. Monitor blood lead and zinc levels.
    B) Refer to the "Lead" document for additional information.
    4.1.2) SERUM/BLOOD
    A) Monitor renal and hepatic function and serum electrolytes. Levels should be checked before each course of therapy and monitored daily during therapy in severe cases and after the second and fifth day of therapy in less serious cases. Monitor zinc levels (Prod Info Calcium disodium versenate, 2004).
    B) Elevation of blood lead level (BLL) is essential to the diagnosis of childhood and industrial cases. Children with a blood lead level of 45 mcg/dL or greater require medical intervention and chelation.
    C) Children with venous BLLs of 20 mcg/dL or greater or with venous BLLs of 15-19 mcg/dL that persist for at least 3 months should receive medical evaluation and treatment. Chelation therapy should be instituted in all children with a blood lead level of 45 mcg/dL or greater using venous blood lead measurement.
    D) Obtain a CBC to assess for anemia and perform a peripheral smear. Hypochromia and basophilic stippling suggest lead intoxication, but they are non-specific and their absence does not rule out the diagnosis.
    E) Employees whose blood lead level is equal to or greater than 50 mcg/100 g shall be temporarily removed from exposure until their blood lead level is at or below 40 mcg/dl.
    4.1.3) URINE
    A) Monitor urinalysis and urine sediment before each course of therapy, daily during therapy in severe cases, and after the second and fifth day of therapy in less serious cases (Prod Info Calcium disodium versenate, 2004).
    4.1.4) OTHER
    A) OTHER
    1) Monitor ECG for cardiac rhythm abnormalities during intravenous therapy (Prod Info Calcium disodium versenate, 2004).
    2) Edetate calcium disodium mobilization tests should not be performed in patients with blood lead levels above 55 mcg/dL or in symptomatic patients for whom chelation therapy is indicated (Prod Info Calcium disodium versenate, 2004).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Monitoring

    A) Monitor renal and hepatic function, serum electrolytes, urinalysis, urine sediment, and ECG. Levels should be checked before each course of therapy and monitored daily during therapy in severe cases and after the second and fifth day of therapy in less serious cases. Monitor blood lead and zinc levels.
    B) Refer to the "Lead" document for additional information.

Range Of Toxicity

Summary

    A) No ill effects were observed following inadvertent administration of 5 times the recommended dose, infused intravenously over a 24 hour period of time, to an asymptomatic 16 month old with a blood lead level of 56 mcg/dL

Therapeutic Dose

    7.2.1) ADULT
    A) BLOOD LEVELS BETWEEN 20 AND 70 MCG/DL AND ASYMPTOMATIC
    1) 1000 mg/m(2) IM (divided into equal doses spaced 8 to 12 hours apart) or IV (infused over 8 to 12 hours) daily for 5 days, followed by a 2- to 4-day rest period in order to allow redistribution of lead; a second course of treatment may then be employed as indicated (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012)
    2) DO NOT exceed recommended dose (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012)
    B) BLOOD LEVELS ABOVE 70 MCG/DL OR SYMPTOMATIC
    1) Use in conjunction with BAL (dimercaprol) (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012)
    2) DO NOT exceed recommended dose (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012)
    C) LEAD ENCEPHALOPATHY
    1) 1500 mg/m(2)/day (approximately 50 to 75 mg/kg/day) is administered as a continuous IV infusion, starting 4 hours after the first dose of dimercaprol and after adequate urine flow is established. The dose, along with dimercaprol therapy, is continued for 5 days, followed by a 2- to 4-day rest period in order to allow redistribution of lead (Howland, 2011).
    D) LEAD NEPHROPATHY
    1) SERUM CREATININE LEVELS BETWEEN 2 AND 3 MG/DL: 500 mg/m(2) IM (divided into equal doses spaced 8 to 12 hours apart) or IV (infused over 8 to 12 hours) every 24 hours for 5 days (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012; Howland, 2011).
    2) SERUM CREATININE LEVELS BETWEEN 3 AND 4 MG/DL: 500 mg/m(2) IM (divided into equal doses spaced 8 to 12 hours apart) or IV (infused over 8 to 12 hours) every 48 hours for 3 doses (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012; Howland, 2011).
    3) SERUM CREATININE LEVELS ABOVE 4 MG/DL: 500 mg/m(2) once weekly IM (divided into equal doses spaced 8 to 12 hours apart) or IV (infused over 8 to 12 hours) (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012; Howland, 2011).
    7.2.2) PEDIATRIC
    A) BLOOD LEVELS BETWEEN 20 AND 70 MCG/DL AND ASYMPTOMATIC
    1) 1000 mg/m(2) IM (divided into equal doses spaced 8 to 12 hours apart) or IV (infused over 8 to 12 hours) daily for 5 days, followed by a 2- to 4-day rest period in order to allow redistribution of lead; a second course of treatment may then be employed as indicated (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012).
    2) DO NOT exceed recommended dose (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012).
    B) BLOOD LEVELS ABOVE 70 MCG/DL OR SYMPTOMATIC
    1) 1000 mg/m(2) (approximately 25 to 50 mg/kg/day) daily for 5 days, followed by a 2- to 4-day rest period in order to allow redistribution of lead; a second course of treatment may then be employed as indicated. Use in conjunction with BAL (dimercaprol) (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012; Howland, 2011).
    2) DO NOT exceed recommended dose (Prod Info Calcium Disodium Versenate intravenous injection, intramuscular injection, 2012)
    C) LEAD ENCEPHALOPATHY
    1) 1500 mg/m(2)/day (approximately 50 to 75 mg/kg/day) is administered as a continuous IV infusion, starting 4 hours after the first dose of dimercaprol and after adequate urine flow is established. The dose, along with dimercaprol therapy, is continued for 5 days, followed by a 2- to 4-day rest period in order to allow redistribution of lead (Howland, 2011).

Minimum Lethal Exposure

    A) In patients with lead encephalopathy, a therapeutic dose may cause worsening cerebral edema, which can be fatal (Prod Info Calcium disodium versenate, 2004).

Maximum Tolerated Exposure

    A) No ill effects were observed following inadvertent administration of 5 times the recommended dose, infused intravenously over a 24 hour period of time, to an asymptomatic 16 month old with a blood lead level of 56 mcg/dL (Prod Info Calcium disodium versenate, 2004).

Workplace Standards

    A) ACGIH TLV Values for CAS62-33-9 (American Conference of Governmental Industrial Hygienists, 2010):
    1) Not Listed

    B) NIOSH REL and IDLH Values for CAS62-33-9 (National Institute for Occupational Safety and Health, 2007):
    1) Not Listed

    C) Carcinogenicity Ratings for CAS62-33-9 :
    1) ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed
    2) EPA (U.S. Environmental Protection Agency, 2011): Not Listed
    3) IARC (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004): Not Listed
    4) NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed
    5) MAK (DFG, 2002): Not Listed
    6) NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed

    D) OSHA PEL Values for CAS62-33-9 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):
    1) Not Listed

Pharmacology Toxicology

Pharmacologic Mechanism

    A) The therapeutic effects are due to the formation of chelates with divalent and trivalent metals. A stable chelate will form with any metal that can displace calcium from the molecule, such as lead (Prod Info Calcium disodium versenate, 2004).

Physicochemical

Molecular Weight

    A) 374.27 (Prod Info Calcium disodium versenate, 2004)

References

General Bibliography

    1) 40 CFR 372.28: Environmental Protection Agency - Toxic Chemical Release Reporting, Community Right-To-Know, Lower thresholds for chemicals of special concern. National Archives and Records Administration (NARA) and the Government Printing Office (GPO). Washington, DC. Final rules current as of Apr 3, 2006.
    2) 40 CFR 372.65: Environmental Protection Agency - Toxic Chemical Release Reporting, Community Right-To-Know, Chemicals and Chemical Categories to which this part applies. National Archives and Records Association (NARA) and the Government Printing Office (GPO), Washington, DC. Final rules current as of Apr 3, 2006.
    3) 49 CFR 172.101 - App. B: Department of Transportation - Table of Hazardous Materials, Appendix B: List of Marine Pollutants. National Archives and Records Administration (NARA) and the Government Printing Office (GPO), Washington, DC. Final rules current as of Aug 29, 2005.
    4) 62 FR 58840: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 1997.
    5) 65 FR 14186: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.
    6) 65 FR 39264: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.
    7) 65 FR 77866: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.
    8) 66 FR 21940: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2001.
    9) 67 FR 7164: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2002.
    10) 68 FR 42710: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2003.
    11) 69 FR 54144: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2004.
    12) AIHA: 2006 Emergency Response Planning Guidelines and Workplace Environmental Exposure Level Guides Handbook, American Industrial Hygiene Association, Fairfax, VA, 2006.
    13) American Conference of Governmental Industrial Hygienists : ACGIH 2010 Threshold Limit Values (TLVs(R)) for Chemical Substances and Physical Agents and Biological Exposure Indices (BEIs(R)), American Conference of Governmental Industrial Hygienists, Cincinnati, OH, 2010.
    14) Angle CR & McIntire MS: Lead poisoning during pregnancy. Am J Dis Child 1964; 108:436-439.
    15) Beauchesne MF & Shalansky SJ: Nonchemotherapy drug-induced agranulocytosis: a review of 118 patients treated with colony-stimulating factors. Pharmacotherapy 1999; 19(3):299-305.
    16) Brownie CF, Brownie C, Noden D, et al: Teratogenic effect of calcium edetate (CaEDTA) in rats and the protective effect of zinc. Toxicol Appl Pharmacol 1986; 82:426-443.
    17) CDC: Screening young children for lead poisoning: Guidance for state and local public health officials., Centers for Disease Control and Prevention , Atlanta, GA, 1997.
    18) Chisholm JJ: The use of chelating agents in the treatment of acute and chronic lead intoxication in childhood. J Pediatr 1968; 73:1.
    19) DFG: List of MAK and BAT Values 2002, Report No. 38, Deutsche Forschungsgemeinschaft, Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area, Wiley-VCH, Weinheim, Federal Republic of Germany, 2002.
    20) EPA: Search results for Toxic Substances Control Act (TSCA) Inventory Chemicals. US Environmental Protection Agency, Substance Registry System, U.S. EPA's Office of Pollution Prevention and Toxics. Washington, DC. 2005. Available from URL: http://www.epa.gov/srs/.
    21) Hartman LC, Tschetter LK, Habermann TM, et al: Granulocyte colony-stimulating factor in severe chemotherapy-induced afebrile neutropenia.. N Engl J Med 1997; 336:1776-1780.
    22) Howland MA: Calcium Disodium. In: Nelson LS, Lewin NA, Howland M, et al, eds. Goldfrank's Toxicologic Emergencies, 9th ed. McGraw Hill, New York, NY, 2011.
    23) IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: 1,3-Butadiene, Ethylene Oxide and Vinyl Halides (Vinyl Fluoride, Vinyl Chloride and Vinyl Bromide), 97, International Agency for Research on Cancer, Lyon, France, 2008.
    24) IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Formaldehyde, 2-Butoxyethanol and 1-tert-Butoxypropan-2-ol, 88, International Agency for Research on Cancer, Lyon, France, 2006.
    25) IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Household Use of Solid Fuels and High-temperature Frying, 95, International Agency for Research on Cancer, Lyon, France, 2010a.
    26) IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines, 89, International Agency for Research on Cancer, Lyon, France, 2007.
    27) IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Some Non-heterocyclic Polycyclic Aromatic Hydrocarbons and Some Related Exposures, 92, International Agency for Research on Cancer, Lyon, France, 2010.
    28) IARC: List of all agents, mixtures and exposures evaluated to date - IARC Monographs: Overall Evaluations of Carcinogenicity to Humans, Volumes 1-88, 1972-PRESENT. World Health Organization, International Agency for Research on Cancer. Lyon, FranceAvailable from URL: http://monographs.iarc.fr/monoeval/crthall.html. As accessed Oct 07, 2004.
    29) International Agency for Research on Cancer (IARC): IARC monographs on the evaluation of carcinogenic risks to humans: list of classifications, volumes 1-116. International Agency for Research on Cancer (IARC). Lyon, France. 2016. Available from URL: http://monographs.iarc.fr/ENG/Classification/latest_classif.php. As accessed 2016-08-24.
    30) International Agency for Research on Cancer: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. World Health Organization. Geneva, Switzerland. 2015. Available from URL: http://monographs.iarc.fr/ENG/Classification/. As accessed 2015-08-06.
    31) Klaasen CD: Heavy metals and heavy-metal antagonists In: Hardman JG & Limbird LE: Goodman & Gilman's The Pharmacological basis of therapeutics, 10th. McGraw-Hill, New York, NY, 2001.
    32) Kleinman ME, Chameides L, Schexnayder SM, et al: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 14: pediatric advanced life support. Circulation 2010; 122(18 Suppl.3):S876-S908.
    33) Mehbod H: Treatment of lead intoxication: combined use of peritoneal dialysis and edetate calcium disodium. JAMA 1967; 201:152-153.
    34) Moel DI & Kumar K: Reversible nephrotoxic reactions to a combined 2,3-dimercapto-1-propanol and calcium disodium ethylenediaminetetraacetic acid regimen in asymptomatic children with elevated blood lead levels. Pediatrics 1982; 70:259-262.
    35) NFPA: Fire Protection Guide to Hazardous Materials, 13th ed., National Fire Protection Association, Quincy, MA, 2002.
    36) NRC: Acute Exposure Guideline Levels for Selected Airborne Chemicals - Volume 1, Subcommittee on Acute Exposure Guideline Levels, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission of Life Sciences, National Research Council. National Academy Press, Washington, DC, 2001.
    37) NRC: Acute Exposure Guideline Levels for Selected Airborne Chemicals - Volume 2, Subcommittee on Acute Exposure Guideline Levels, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission of Life Sciences, National Research Council. National Academy Press, Washington, DC, 2002.
    38) NRC: Acute Exposure Guideline Levels for Selected Airborne Chemicals - Volume 3, Subcommittee on Acute Exposure Guideline Levels, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission of Life Sciences, National Research Council. National Academy Press, Washington, DC, 2003.
    39) NRC: Acute Exposure Guideline Levels for Selected Airborne Chemicals - Volume 4, Subcommittee on Acute Exposure Guideline Levels, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission of Life Sciences, National Research Council. National Academy Press, Washington, DC, 2004.
    40) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,2,3-Trimethylbenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2006k. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d68a&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    41) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,2,4-Trimethylbenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2006m. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d68a&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    42) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,2-Butylene Oxide (Proposed). United States Environmental Protection Agency. Washington, DC. 2008d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648083cdbb&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    43) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,2-Dibromoethane (Proposed). United States Environmental Protection Agency. Washington, DC. 2007g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064802796db&disposition=attachment&contentType=pdf. As accessed 2010-08-18.
    44) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,3,5-Trimethylbenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2006l. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d68a&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    45) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 2-Ethylhexyl Chloroformate (Proposed). United States Environmental Protection Agency. Washington, DC. 2007b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648037904e&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    46) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Acrylonitrile (Proposed). United States Environmental Protection Agency. Washington, DC. 2007c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648028e6a3&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    47) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Adamsite (Proposed). United States Environmental Protection Agency. Washington, DC. 2007h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    48) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Agent BZ (3-quinuclidinyl benzilate) (Proposed). United States Environmental Protection Agency. Washington, DC. 2007f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064803ad507&disposition=attachment&contentType=pdf. As accessed 2010-08-18.
    49) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Allyl Chloride (Proposed). United States Environmental Protection Agency. Washington, DC. 2008. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648039d9ee&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    50) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Aluminum Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    51) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Arsenic Trioxide (Proposed). United States Environmental Protection Agency. Washington, DC. 2007m. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480220305&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    52) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Automotive Gasoline Unleaded (Proposed). United States Environmental Protection Agency. Washington, DC. 2009a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7cc17&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    53) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Biphenyl (Proposed). United States Environmental Protection Agency. Washington, DC. 2005j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064801ea1b7&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    54) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Bis-Chloromethyl Ether (BCME) (Proposed). United States Environmental Protection Agency. Washington, DC. 2006n. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648022db11&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    55) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Boron Tribromide (Proposed). United States Environmental Protection Agency. Washington, DC. 2008a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064803ae1d3&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    56) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Bromine Chloride (Proposed). United States Environmental Protection Agency. Washington, DC. 2007d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648039732a&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    57) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Bromoacetone (Proposed). United States Environmental Protection Agency. Washington, DC. 2008e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064809187bf&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    58) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Calcium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    59) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Carbonyl Fluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2008b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064803ae328&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    60) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Carbonyl Sulfide (Proposed). United States Environmental Protection Agency. Washington, DC. 2007e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648037ff26&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    61) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Chlorobenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2008c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064803a52bb&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    62) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Cyanogen (Proposed). United States Environmental Protection Agency. Washington, DC. 2008f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064809187fe&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    63) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Dimethyl Phosphite (Proposed). United States Environmental Protection Agency. Washington, DC. 2009. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7cbf3&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    64) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Diphenylchloroarsine (Proposed). United States Environmental Protection Agency. Washington, DC. 2007l. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    65) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ethyl Isocyanate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648091884e&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    66) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ethyl Phosphorodichloridate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480920347&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    67) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ethylbenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2008g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064809203e7&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    68) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ethyldichloroarsine (Proposed). United States Environmental Protection Agency. Washington, DC. 2007j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    69) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Germane (Proposed). United States Environmental Protection Agency. Washington, DC. 2008j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963906&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    70) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Hexafluoropropylene (Proposed). United States Environmental Protection Agency. Washington, DC. 2006. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064801ea1f5&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    71) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ketene (Proposed). United States Environmental Protection Agency. Washington, DC. 2007. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ee7c&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    72) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Magnesium Aluminum Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    73) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Magnesium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    74) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Malathion (Proposed). United States Environmental Protection Agency. Washington, DC. 2009k. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064809639df&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    75) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Mercury Vapor (Proposed). United States Environmental Protection Agency. Washington, DC. 2009b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a8a087&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    76) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyl Isothiocyanate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008k. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963a03&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    77) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyl Parathion (Proposed). United States Environmental Protection Agency. Washington, DC. 2008l. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963a57&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    78) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyl tertiary-butyl ether (Proposed). United States Environmental Protection Agency. Washington, DC. 2007a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064802a4985&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    79) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methylchlorosilane (Proposed). United States Environmental Protection Agency. Washington, DC. 2005. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5f4&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    80) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyldichloroarsine (Proposed). United States Environmental Protection Agency. Washington, DC. 2007i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    81) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyldichlorosilane (Proposed). United States Environmental Protection Agency. Washington, DC. 2005a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c646&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    82) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Mustard (HN1 CAS Reg. No. 538-07-8) (Proposed). United States Environmental Protection Agency. Washington, DC. 2006a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d6cb&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    83) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Mustard (HN2 CAS Reg. No. 51-75-2) (Proposed). United States Environmental Protection Agency. Washington, DC. 2006b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d6cb&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    84) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Mustard (HN3 CAS Reg. No. 555-77-1) (Proposed). United States Environmental Protection Agency. Washington, DC. 2006c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d6cb&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    85) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Tetroxide (Proposed). United States Environmental Protection Agency. Washington, DC. 2008n. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648091855b&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    86) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Trifluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2009l. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963e0c&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    87) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Parathion (Proposed). United States Environmental Protection Agency. Washington, DC. 2008o. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963e32&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    88) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Perchloryl Fluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2009c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7e268&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    89) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Perfluoroisobutylene (Proposed). United States Environmental Protection Agency. Washington, DC. 2009d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7e26a&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    90) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phenyl Isocyanate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008p. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096dd58&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    91) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phenyl Mercaptan (Proposed). United States Environmental Protection Agency. Washington, DC. 2006d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020cc0c&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    92) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phenyldichloroarsine (Proposed). United States Environmental Protection Agency. Washington, DC. 2007k. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    93) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phorate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008q. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096dcc8&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    94) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phosgene (Draft-Revised). United States Environmental Protection Agency. Washington, DC. 2009e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a8a08a&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    95) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phosgene Oxime (Proposed). United States Environmental Protection Agency. Washington, DC. 2009f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7e26d&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    96) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Potassium Cyanide (Proposed). United States Environmental Protection Agency. Washington, DC. 2009g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7cbb9&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    97) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Potassium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    98) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Propargyl Alcohol (Proposed). United States Environmental Protection Agency. Washington, DC. 2006e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ec91&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    99) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Selenium Hexafluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2006f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ec55&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    100) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Silane (Proposed). United States Environmental Protection Agency. Washington, DC. 2006g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d523&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    101) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Sodium Cyanide (Proposed). United States Environmental Protection Agency. Washington, DC. 2009h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7cbb9&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
    102) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Sodium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    103) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Strontium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    104) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Sulfuryl Chloride (Proposed). United States Environmental Protection Agency. Washington, DC. 2006h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ec7a&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    105) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Tear Gas (Proposed). United States Environmental Protection Agency. Washington, DC. 2008s. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096e551&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    106) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Tellurium Hexafluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2009i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7e2a1&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    107) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Tert-Octyl Mercaptan (Proposed). United States Environmental Protection Agency. Washington, DC. 2008r. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096e5c7&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    108) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Tetramethoxysilane (Proposed). United States Environmental Protection Agency. Washington, DC. 2006j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d632&disposition=attachment&contentType=pdf. As accessed 2010-08-17.
    109) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Trimethoxysilane (Proposed). United States Environmental Protection Agency. Washington, DC. 2006i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d632&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    110) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Trimethyl Phosphite (Proposed). United States Environmental Protection Agency. Washington, DC. 2009j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7d608&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    111) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Trimethylacetyl Chloride (Proposed). United States Environmental Protection Agency. Washington, DC. 2008t. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096e5cc&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    112) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Zinc Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
    113) National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for n-Butyl Isocyanate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008m. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064808f9591&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
    114) National Institute for Occupational Safety and Health: NIOSH Pocket Guide to Chemical Hazards, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Cincinnati, OH, 2007.
    115) National Research Council : Acute exposure guideline levels for selected airborne chemicals, 5, National Academies Press, Washington, DC, 2007.
    116) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 6, National Academies Press, Washington, DC, 2008.
    117) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 7, National Academies Press, Washington, DC, 2009.
    118) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 8, National Academies Press, Washington, DC, 2010.
    119) Osterloh J & Becker CE: Pharmacokinetics of CaNa2EDTA and chelation of lead in renal failure. Clin Pharmacol Ther 1986; 40:686-693.
    120) Peberdy MA , Callaway CW , Neumar RW , et al: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science. Part 9: post–cardiac arrest care. Circulation 2010; 122(18 Suppl 3):S768-S786.
    121) Product Information: Calcium Disodium Versenate intravenous injection, intramuscular injection, edetate calcium disodium intravenous injection, intramuscular injection. Medicis, The Dermatology Company (per DailyMed), Scottsdale, AZ, 2012.
    122) Product Information: Calcium disodium versenate, edetate calcium disodium injection. 3M Pharmaceuticals, Northridge, CA, USA, 2004.
    123) Product Information: LEUKINE(R) injection, sargramostim injection. Berlex, Seattle, WA, 2006.
    124) Product Information: NEUPOGEN(R) injection, filgrastim injection. Amgen,Inc, Thousand Oaks, CA, 2006.
    125) Product Information: dopamine hcl, 5% dextrose IV injection, dopamine hcl, 5% dextrose IV injection. Hospira,Inc, Lake Forest, IL, 2004.
    126) Product Information: norepinephrine bitartrate injection, norepinephrine bitartrate injection. Sicor Pharmaceuticals,Inc, Irvine, CA, 2005.
    127) Schardein JL, Sakowski R, Petrere J, et al: Teratogenesis studies with EDTA and its salts in rats. Toxicol Appl Pharmacol 1981; 61:423-428.
    128) Seven MJ (Ed): Observations on the toxicity of intravenous chelating agents, in Metal-Binding in Medicine, JB Lippincott Co, Philadelphia, PA, 1960.
    129) Stull DM, Bilmes R, Kim H, et al: Comparison of sargramostim and filgrastim in the treatment of chemotherapy-induced neutropenia. Am J Health Syst Pharm 2005; 62(1):83-87.
    130) U.S. Department of Energy, Office of Emergency Management: Protective Action Criteria (PAC) with AEGLs, ERPGs, & TEELs: Rev. 26 for chemicals of concern. U.S. Department of Energy, Office of Emergency Management. Washington, DC. 2010. Available from URL: http://www.hss.doe.gov/HealthSafety/WSHP/Chem_Safety/teel.html. As accessed 2011-06-27.
    131) U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project : 11th Report on Carcinogens. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Washington, DC. 2005. Available from URL: http://ntp.niehs.nih.gov/INDEXA5E1.HTM?objectid=32BA9724-F1F6-975E-7FCE50709CB4C932. As accessed 2011-06-27.
    132) U.S. Environmental Protection Agency: Discarded commercial chemical products, off-specification species, container residues, and spill residues thereof. Environmental Protection Agency's (EPA) Resource Conservation and Recovery Act (RCRA); List of hazardous substances and reportable quantities 2010b; 40CFR(261.33, e-f):77-.
    133) U.S. Environmental Protection Agency: Integrated Risk Information System (IRIS). U.S. Environmental Protection Agency. Washington, DC. 2011. Available from URL: http://cfpub.epa.gov/ncea/iris/index.cfm?fuseaction=iris.showSubstanceList&list_type=date. As accessed 2011-06-21.
    134) U.S. Environmental Protection Agency: List of Radionuclides. U.S. Environmental Protection Agency. Washington, DC. 2010a. Available from URL: http://www.gpo.gov/fdsys/pkg/CFR-2010-title40-vol27/pdf/CFR-2010-title40-vol27-sec302-4.pdf. As accessed 2011-06-17.
    135) U.S. Environmental Protection Agency: List of hazardous substances and reportable quantities. U.S. Environmental Protection Agency. Washington, DC. 2010. Available from URL: http://www.gpo.gov/fdsys/pkg/CFR-2010-title40-vol27/pdf/CFR-2010-title40-vol27-sec302-4.pdf. As accessed 2011-06-17.
    136) U.S. Environmental Protection Agency: The list of extremely hazardous substances and their threshold planning quantities (CAS Number Order). U.S. Environmental Protection Agency. Washington, DC. 2010c. Available from URL: http://www.gpo.gov/fdsys/pkg/CFR-2010-title40-vol27/pdf/CFR-2010-title40-vol27-part355.pdf. As accessed 2011-06-17.
    137) U.S. Occupational Safety and Health Administration: Part 1910 - Occupational safety and health standards (continued) Occupational Safety, and Health Administration's (OSHA) list of highly hazardous chemicals, toxics and reactives. Subpart Z - toxic and hazardous substances. CFR 2010 2010; Vol6(SEC1910):7-.
    138) U.S. Occupational Safety, and Health Administration (OSHA): Process safety management of highly hazardous chemicals. 29 CFR 2010 2010; 29(1910.119):348-.
    139) United States Environmental Protection Agency Office of Pollution Prevention and Toxics: Acute Exposure Guideline Levels (AEGLs) for Vinyl Acetate (Proposed). United States Environmental Protection Agency. Washington, DC. 2006. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d6af&disposition=attachment&contentType=pdf. As accessed 2010-08-16.