![]() La méthode d’élaboration utilisée est celle des Recommandations pour la pratique clinique (RPC) de la HAS (HAS, 2010). À la demande de la Direction générale de la santé, la Haute Autorité de santé (HAS), en partenariat avec la Société de toxicologie clinique (STC) et avec la collaboration de la Société française de médecine du travail (SFMT), la Société française de santé publique (SFSP), la Société française de toxicologie analytique (SFTA) et la Société francophone de santé-environnement (SFSE) a élaboré des recommandations pour le dépistage des surexpositions environnementales à l’arsenic inorganique (Asi) et la prise en charge des populations concernées. At this stage of their development, it is very difficult for the clinician to obtain funds to study them clinically even though they appear to be useful for treatment of poisoning by any one of the heavy metals. These dimercapto compounds are in a great many respects orphan drugs. ![]() The usefulness of all these dimercapto compounds would be enhanced by a careful study of their metabolism and biotransformation. Of them all, DMPS is most potent and BAL appears to be the least potent. The sodium arsenite inhibition of the pyruvate dehydrogenase (PDH) complex can be prevented and reversed in vitro or in vivo by DMPS, DMSA, DMPA, or BAL. DMPS and DMSA have promise as prophylactics for the prevention of the vesicant action of Lewisite. Either DMSA or DMPS, when given sc or po, will protect rabbits against the lethal systemic effects of subcutaneously administered Lewisite. These results raise the question as to the appropriateness of BAL as the treatment for systemic arsenic poisoning. ![]() BAL, however, increases the arsenic content of the brain of rabbits injected with sodium arsenite. DMPS, DMPA, or DMSA will mobilize tissue arsenic. The relative effectiveness or therapeutic index of these dimercapto compounds in protecting mice from the lethal effects of an LD99 of sodium arsenite is DMSA > DMPS > DMPA > BAL in the magnitude of 42:14:4:1, respectively. Meso-Dimercaptosuccinic acid (DMSA), 2,3-dimercapto-1-propanesulfonic acid, Na salt (DMPS), and N-(2,3-dimercaptopropyl)-phthalamidic acid (DMPA) are water soluble analogs of 2,3-dimercapto-1-propanol (BAL).
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