N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases
Systemic toxicity associated with cobalt (Co) and chromium (Cr) containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patien...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2016/8682737 |
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| author | Andrea Giampreti Davide Lonati Benedetta Ragghianti Anna Ronchi Valeria Margherita Petrolini Sarah Vecchio Carlo Alessandro Locatelli |
| author_facet | Andrea Giampreti Davide Lonati Benedetta Ragghianti Anna Ronchi Valeria Margherita Petrolini Sarah Vecchio Carlo Alessandro Locatelli |
| author_sort | Andrea Giampreti |
| collection | DOAJ |
| description | Systemic toxicity associated with cobalt (Co) and chromium (Cr) containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patients in which N-acetyl-cysteine decreased elevated blood metal levels. A 67-year-old male who underwent Co/Cr hip implant in September 2009 referred to our Poison Control Centre for persisting elevated Co/Cr blood levels (from March 2012 to November 2014). After receiving oral high-dose N-acetyl-cysteine, Co/Cr blood concentrations dropped by 86% and 87% of the prechelation levels, respectively, and persisted at these latter concentrations during the following 6 months of follow-up. An 81-year-old female who underwent Co/Cr hip implant in January 2007 referred to our Centre for detection of high Co and Cr blood levels in June 2012. No hip revision was indicated. After a therapy with oral high-dose N-acetyl-cysteine Co/Cr blood concentrations decreased of 45% and 24% of the prechelation levels. Chelating agents reported in hip-implanted patients (EDTA, DMPS, and BAL) are described in few cases. N-acetyl-cysteine may provide chelating sites for metals and in our cases reduced Co and Cr blood levels and resulted well tolerable. |
| format | Article |
| id | doaj-art-b485c2f4f8aa4590a7fa7467ba1bb2e0 |
| institution | Kabale University |
| issn | 2090-6749 2090-6757 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Orthopedics |
| spelling | doaj-art-b485c2f4f8aa4590a7fa7467ba1bb2e02025-08-20T03:39:22ZengWileyCase Reports in Orthopedics2090-67492090-67572016-01-01201610.1155/2016/86827378682737N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two CasesAndrea Giampreti0Davide Lonati1Benedetta Ragghianti2Anna Ronchi3Valeria Margherita Petrolini4Sarah Vecchio5Carlo Alessandro Locatelli6Pavia Poison Centre and National Toxicology Information Centre, IRCCS Maugeri Foundation Clinical Institute and University of Pavia, 27100 Pavia, ItalyPavia Poison Centre and National Toxicology Information Centre, IRCCS Maugeri Foundation Clinical Institute and University of Pavia, 27100 Pavia, ItalyDiabetes Agency, Careggi Teaching Hospital, 50134 Firenze, ItalyPavia Poison Centre and National Toxicology Information Centre, IRCCS Maugeri Foundation Clinical Institute and University of Pavia, 27100 Pavia, ItalyPavia Poison Centre and National Toxicology Information Centre, IRCCS Maugeri Foundation Clinical Institute and University of Pavia, 27100 Pavia, ItalyPavia Poison Centre and National Toxicology Information Centre, IRCCS Maugeri Foundation Clinical Institute and University of Pavia, 27100 Pavia, ItalyPavia Poison Centre and National Toxicology Information Centre, IRCCS Maugeri Foundation Clinical Institute and University of Pavia, 27100 Pavia, ItalySystemic toxicity associated with cobalt (Co) and chromium (Cr) containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patients in which N-acetyl-cysteine decreased elevated blood metal levels. A 67-year-old male who underwent Co/Cr hip implant in September 2009 referred to our Poison Control Centre for persisting elevated Co/Cr blood levels (from March 2012 to November 2014). After receiving oral high-dose N-acetyl-cysteine, Co/Cr blood concentrations dropped by 86% and 87% of the prechelation levels, respectively, and persisted at these latter concentrations during the following 6 months of follow-up. An 81-year-old female who underwent Co/Cr hip implant in January 2007 referred to our Centre for detection of high Co and Cr blood levels in June 2012. No hip revision was indicated. After a therapy with oral high-dose N-acetyl-cysteine Co/Cr blood concentrations decreased of 45% and 24% of the prechelation levels. Chelating agents reported in hip-implanted patients (EDTA, DMPS, and BAL) are described in few cases. N-acetyl-cysteine may provide chelating sites for metals and in our cases reduced Co and Cr blood levels and resulted well tolerable.http://dx.doi.org/10.1155/2016/8682737 |
| spellingShingle | Andrea Giampreti Davide Lonati Benedetta Ragghianti Anna Ronchi Valeria Margherita Petrolini Sarah Vecchio Carlo Alessandro Locatelli N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases Case Reports in Orthopedics |
| title | N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases |
| title_full | N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases |
| title_fullStr | N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases |
| title_full_unstemmed | N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases |
| title_short | N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases |
| title_sort | n acetyl cysteine as effective and safe chelating agent in metal on metal hip implanted patients two cases |
| url | http://dx.doi.org/10.1155/2016/8682737 |
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