1) Headache, lightheadedness, pruritus, nausea, vomiting, diarrhea, pelvic pain, and trace element deficiency have been reported following therapeutic use of pentetate zinc trisodium (Zn-DTPA).

1) There is no current information regarding acute overdose in humans.

1) Treatment is symptomatic and supportive.

1) Treatment is symptomatic and supportive. Correct any electrolyte abnormalities, as necessary. NOTE: A patient exposed to radiation requires concomitant monitoring and treatment for radiation toxicity; see RADIATION management, as appropriate.

1) Gastrointestinal decontamination is not recommended; administered via the parenteral or inhalational routes.

1) Airway management is very unlikely to be necessary.

1) None.

1) There is no information regarding the effectiveness of hemodialysis or hemoperfusion for the removal of pentetate zinc trisodium from plasma.

1) HOME CRITERIA: Home exposure is unlikely to occur. A patient with an inadvertent exposure, that remains asymptomatic can be managed at home.
2) OBSERVATION CRITERIA: Patients with a deliberate overdose, and those who are symptomatic, need to be monitored for several hours to assess electrolyte and fluid balance and gastrointestinal function. Patients with underlying cardiac abnormalities may require ECG monitoring in addition to electrolyte/fluid analysis. Patients that remain asymptomatic can be discharged.
3) ADMISSION CRITERIA: Patients with significant gastrointestinal symptoms and persistent electrolyte imbalances likely need to be admitted for further treatment and monitoring.
4) CONSULT CRITERIA: Consult a Poison Center or medical toxicologist for assistance in managing patients with severe toxicity or for whom diagnosis is unclear.

1) Appropriate therapy may be delayed due to failure to diagnose radiation exposure.

1) Absorption: poorly absorbed in the GI tract. Metabolism: minimal. In the first few hours after administration, Zn-DTPA is cleared from the plasma through urinary excretion by glomerular filtration. By 24 hours after administration, cumulative urinary excretion was greater than 99% of the injected dose.

1) Patients with underlying electrolyte imbalance may develop more severe symptoms. If a radiation exposure has occurred, symptoms observed may be related to radiation toxicity.

1) WITH THERAPEUTIC USE

1) WITH THERAPEUTIC USE

1) WITH THERAPEUTIC USE

1) WITH THERAPEUTIC USE

1) Mouse studies have demonstrated no evidence of impaired fertility or fetal harm with multiple doses of pentetate zinc trisodium (Zn-DTPA). Mice received Zn-DTPA at doses 31 times the recommended daily human dose. A slight decrease in average birth weight was the only reported effect (Prod Info Pentetate Zinc Trisodium Injection, 2004).

1) The US Food and Drug Administration's Pregnancy Category B (Prod Info Pentetate Zinc Trisodium Injection, 2004).
2) It is recommended that chelation treatment for pregnancy women begin and continue with Zn-DTPA, if available, except in cases of high intenal contamination with radioactive material. The risk of radiation-induced toxicity to the mother and fetus must be weighed against the risk of toxicity with Zn-DTPA therapy. Since Ca-DTPA is more effective than Zn-DTPA in the first 24 hours after high internal contamination, a single dose of Ca-DTPA with zinc-containing vitamin and mineral supplements may be an appropriate initial treatment. In these cases, the risk of radiation-induced toxicity to the mother and fetus must be weighed against the risk of toxicity with Ca-DTPA therapy (Prod Info Pentetate Calcium Trisodium Injection, 2004; Prod Info Pentetate Zinc Trisodium Injection, 2004).

1) Measure the radioactivity in blood, urine, and fecal samples weekly to monitor the radioactive contaminant elimination rate. A baseline estimate of the total body burden of transuranium element should be obtained by whole-body counting and bioassay when possible.

A) Patients with significant gastrointestinal symptoms and persistent electrolyte imbalances likely need to be admitted for further treatment and monitoring.

A) Home exposure is unlikely to occur. A patient with an inadvertent exposure, that remains asymptomatic can be managed at home.

A) Consult a Poison Center or medical toxicologist for assistance in managing patients with severe toxicity or for whom diagnosis is unclear.

A) Patients with a deliberate overdose, and those who are symptomatic, need to be monitored for several hours to assess electrolyte and fluid balance and gastrointestinal function. Patients with underlying cardiac abnormalities may require ECG monitoring in addition to electrolyte/fluid analysis. Patients that remain asymptomatic can be discharged.

1) See the PARENTERAL EXPOSURE treatment section for further information.

1) INITIAL DOSE - During the first 24 hours after internal contamination, it is recommended to administer pentetate calcium trisodium (Ca-DTPA) as the initial dose, followed by Zn-DTPA for maintenance therapy. A single intravenous dose of 1 gram of Ca-DTPA is recommended (Prod Info Pentetate Calcium Trisodium Injection, 2004; Prod Info Pentetate Zinc Trisodium Injection, 2004)
2) Zn-DTPA intravenous route (1 gram in 5 mL solution either by a slow intravenous push over 3 to 4 minutes or by intravenous infusion diluted in 100 to 250 milliliters of 5% dextrose in water, lactated Ringer's, or normal saline) is recommended. The intravenous route should be used if the route of internal contamination is not known or if multiple routes of internal contamination are likely (Prod Info Pentetate Zinc Trisodium Injection, 2004).
3) Patients should drink plenty of fluids and void frequently to promote dilution of the chelated radiocontaminant in the urine and reduce radiation exposure directly to the bladder (Prod Info Pentetate Zinc Trisodium Injection, 2004).
4) Other therapies may be needed (eg; Prussian blue, potassium iodide) if internal contamination with agents other than plutonium, americium, or curium is suspected, or if the radiocontaminant is unknown (Prod Info Pentetate Zinc Trisodium Injection, 2004).
5) MAINTENANCE DOSE - The day after the initial dose, if additional chelation therapy is needed, pentetate zinc trisodium (Zn-DTPA) is preferred, if available, due to safety concerns with prolonged Ca-DTPA administration.An intravenous dose of 1 gram of Zn-DTPA once daily is recommended for maintenance treatmen. Ca-DTPA should not be given simultaneously with Zn-DTPA (Prod Info Pentetate Calcium Trisodium Injection, 2004; Prod Info Pentetate Zinc Trisodium Injection, 2004).

1) If internal contamination is only by inhalation, patients can receive Zn-DTPA by nebulized inhalation. Dilute Zn-DTPA for nebulization at a 1:1 ratio with sterile water or saline. After nebulization, patients should not swallow any expectorant (Prod Info Pentetate Zinc Trisodium Injection, 2004).

1) ADOLESCENTS -
2) CHILDREN LESS THAN 12 YEARS OF AGE -

1) ADOLESCENTS - If internal contamination is only by inhalation, patients can receive Zn-DTPA by nebulized inhalation. Dilute Zn-DTPA for nebulization at a 1:1 ratio with sterile water or saline. After nebulization, patients should not swallow any expectorant (Prod Info Pentetate Zinc Trisodium Injection, 2004).
2) CHILDREN LESS THAN 12 YEARS OF AGE - The safety and efficacy of the nebulized route of administration have not been established in children (Prod Info Pentetate Zinc Trisodium Injection, 2004).