Lead poisoning and chelation in a mother-neonate pair

We report the case of a pregnant woman with chronic lead toxicity and a blood lead of 57 μg/dL (2.7 μmol/L) who gave birth to a healthy-appearing neonate with a cord blood lead of 126 μg/dL (6.08 μmol/L). The mother was prescribed a single course of oral succimer late in the third trimester of pregnancy, without any appreciable change in her blood lead. The neonate was initially treated with intramuscular dimercaprol and intravenous edetate calcium disodium. After 3 days, the neonate was then switched to oral 2,3-dimercaptosuccinic acid because the blood lead had declined. The child received two 19-day courses of 2,3-dimercaptosuccinic acid and had a blood lead level of 21.5 μg/dL (1.04 μmol/L) at 5 months of age. Despite extensive investigation, the precise source of the mother's lead toxicity remained undetermined.