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Lead toxicokinetics. Development of a biokinetic model to understand and predict the outcome of treatment.

Quite often physicians contact the Dutch Poisons Control Centre for information on patients with increased lead exposure. The most important questions raised by physicians dealing with these patients are how to estimate the lead exposure and the total lead body burden, how to interpret blood lead concentrations and whether the patient needs treatment. In order to answer these questions we need knowledge of the toxicokinetics of lead in the human body. To achieve insight and to make this knowledge accessible to physicians a biokinetic model for lead metabolism in the human body was developed. A four-compartment model with first-order kinetics, based on the concept of Kneip, was used. A biokinetic model uses a mathematical approach to translate the complex biological and kinetic behaviour of lead. In order to develop this biokinetic model two computer programmes were used. At the moment the model is tested with clinical data from patient treated at the medical toxicology outpatient clinic of the Utrecht University Hospital (this department cooperates very closely with the National Poisons Control Centre). Especially with regard to chelation therapy for elevated blood lead levels due to chronic exposure, the model is very helpful in visualising the toxicokinetics of lead in the human body. Toxicokinetic model might help improve knowledge of lead toxicokinetics, leading to well-considered guidelines for treatment of lead intoxications.