ICIM Blog

Question : I am starting to see a pattern if a few patients with high cadmium and/or lead, who also have gadolinium that is elevated, not respond as well as patients without the gadolinium. These are usually cancer patients in whom MRI scans or CT scans have been performed. Have you seen the same thing? I do not know what the affinity coefficient for gadolinium relative to the other metals is. Is it preferentially being picked up by CA EDTA over cadmium or lead, or is it just that there is so much of it because it was given in a high dose that it is interfering with the chelation and removal of the other heavy metals. Some of the patients in question have had 3-4 scans in 1 year. I am trying everything I know to improve excretion, including using IV Glutathione and also Glycine preloading.

As always, I appreciate your help and input, An ICIM Member

Responses:
From Robban Sica MD
Here is an article on NSF and Gadolinium The conference at Yale was on Nephrogenic System Fibrosis caused by Gd
Biochemical safety profiles of gadolinium-based extracellular contrast agents and nephrogenic systemic fibrosis. From the National Center for Biotechnology Information at the U.S. National Library of Medicine.
(Robban also sent a variety of other articles and pdfs)
From Rebecca Murray, APRN

1. Found positive urine toxic (Genova) for gadolinium levels following a challenge of DSMA 500 mg at bedtime with an overnight (7 hour) first void urine collection.

2. Check out http://cme.yale.edu for the program they held in May (?10th)

3. Biochemical safety profiles of gadolinium-based extracellular contrast agents and nephrogenic systemic fibrosis.

Ersoy H, Rybicki FJ.

Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. hersoy@partners.org

Gadolinium (Gd)-based paramagnetic contrast agents are relatively safe when used in clinically recommended doses. However, with the rapidly expanding body of literature linking Gd-based paramagnetic contrast agents and nephrogenic systemic fibrosis (NSF), awareness of the potential side effects and adverse reactions from Gd is now an important requirement for practicing radiologists. In addition to the ongoing accumulation and analyses of clinical NSF data, it is also essential for the practicing radiologist to understand the biochemical characteristics of the extracellular Gd-chelates. The purpose of this review is to consolidate and update the available information on known side effects, adverse reactions, and toxicity of the Gd chelates, with particular emphasis on the potential mechanisms of NSF.

Publication Types:
• Review, PMID: 17969161 [PubMed - indexed for MEDLINE]

From Dr. Martin Dayton:

:Nat Clin Pract Nephrol. 2007; 3(12):654-668. ©2007
http://www.ajronline.org/cgi/reprint/142/3/619.pdf

From Dr. Jim Smith:

1. Has an imaging agent gadolinium is connected to DTPA – Diethylene triamine pentaacetic acid. This is very similar to EDTA. I have heard of EDTA being used in the past. But I guess you could use DTPA if you were so inclined but I have no idea what the dosage would be. (NB: DPTA has not been approved for use in the US, has it?)

2. Go tot the link below and Look at Chap 9 - lot of info on Gadolinium - very toxic, etc
http://books.google.com/books?id=iVMSJUwKY8sC&pg=PA349&lpg=PA349&dq=EDTA+aff
inity+for+gadolinium&source=web&ots=LKF-QglHa_&sig=aax55EwzbrTz0eBOMi3DX
inity+for+gOGY
NU&hl=en&sa=X&oi=book_result&resnum=6&ct=result#PPA313,M1

From Dr. Dale Guyer:
I have seen this a lot in people w contrast agents. While I am not sure of the chelating agent binding coefficents I have always seen the levels on provocation testing drop after using lower dose EDTA and DMPS in combination in conjunction w a modified Myers cocktail. Have usually included 10 cc glutathione and 10,000 mcg of methyl b12 and 5 cc EDTA 2 cc DMPS. I usually put the DMPS in IVPB.

*This discussion is for conversation use only and does not represent medical advice or claims.