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BAL on Back Order
The Ontario Poison Centre has become aware that British Anti-Lewisite (BAL) is currently on back order. It is expected that this antidote (chelator) may be available by mid to late January 2019. As some hospital pharmacies have noted that their current supply of BAL is expiring, the OPC has made suggestions for alternative treatment of heavy metal poisonings until the supply of BAL improves. See recommendations and supporting documents below:
Kosnett, M. (2013). The role of chelation in the treatment of arsenic and mercury poisoning. Journal of Medical Toxicology. 9: 347-354.
Bjorklund, G., Mutter, J. & Aaseth, J. (2017). Metal chelators and neurotoxicity: lead, mercury and arsenic. Archives of Toxicology. 91: 3787-3797.
Chisolm, J. & Thomas, D. (1985). Use of 2, 3 - dimercaptopropane -1 - sulfonate in treatment of lead poisoning in children. The Journal of Pharmacology and Experimental Therapeutics. 235 (3): 665-669.