Accidents can happen in our lives at unexpected times. Imagine, what would you do if someone suddenly ingested a heavy metal like arsenic, mercury, gold, or lead and became poisoned? This is a very dangerous situation. Today we are talking about a special injection that is only given in a hospital in such a serious case. The name of this injection is Dimercaprol. You may have seen it sometimes called 'BAL in Oil'.
Simply put, what is Dimercaprol?
This is a bit complicated, but let's keep it simple. Imagine that a harmful heavy metal has entered your body. These metal particles bind to various tissues and organs in the body and begin to damage them. The drug Dimercaprol works like a strong magnet .
When this vaccine enters the body, it attracts the harmful heavy metal particles inside it and binds strongly with them. After binding in this way, those toxic metals can no longer harm the body. After that, this Dimercaprol medicine captures those metal particles and passes out of the body with urine. Simply put, this is a process that "picks up and removes" the toxins inside the body. This process is called chelation in medicine.
Things you need to tell your doctor before giving this medicine
Even though this is an emergency medication, it is extremely important that the medical team is aware of certain information about your or the patient's health condition, as this information will determine the success and safety of the treatment.
- Other illnesses you have:
- Kidney disease: Since this medication is excreted from the body through the kidneys, it is important to tell your doctor if you have any kidney problems.
- Liver disease: If there is any problem with liver function, it is important to inform the doctor.
- G6PD deficiency: This is an enzyme deficiency that some people are born with, which is involved in red blood cells. If you have this condition, your doctor should be especially careful about giving you this medication.
- Allergies you have:
- Tell us if you are allergic to this Dimercaprol medicine or any other medicine, food, or dye.
- Specifically, this medication comes in an oil base. Some products may contain peanut oil. So if you have a peanut allergy , be sure to tell your doctor.
- Other poisonings: This medicine is not used to treat metal poisonings such as iron, cadmium, or selenium. If there is any suspicion of such a condition, it should also be mentioned.
- Pregnancy and breastfeeding: If you are pregnant, trying to become pregnant, or breastfeeding, it is essential to inform your doctor before taking this medicine.
The most important thing is to tell your doctor everything you know about your health, without hiding anything. It's for your own safety.
How is this vaccine used?
This is a very important point. Dimercaprol is not a medicine that you can buy at a pharmacy and take home.
- This is only provided by a trained health care professional in a hospital or clinical setting .
- The vaccine is given by injection into a muscle , usually into the deep muscle of the buttocks or thighs.
- Special care is required when giving this medicine to young children . Therefore, this should be done after consulting a pediatrician and following his/her advice.
What to do if the dose of the vaccine is increased?
Since this is given in a hospital, the chance of overdose is very low. However, if you think you have taken too much of this medicine, inform the medical staff immediately. In Sri Lanka, there is a place where you can immediately contact for expert advice on such poisonings and medicines. That is, the National Poisons Information Centre at the National Hospital in Colombo . It is also very important to inform the hospital’s Emergency Treatment Unit (ETU) .
Other things that may interact with this medicine (Interactions)
When taking the Dimercaprol vaccine, there are a few things you should not take with it. Taking these together can cause adverse effects.
| Substances not to be taken | Why is it important? |
|---|---|
| Iron salts or supplements | Iron tablets or other supplements containing iron can form a toxic compound when taken with this medicine. Therefore, iron should be avoided during this treatment. |
| Gold compounds | This medicine should not be used with gold-containing medications (e.g. auranofin, aurothioglucose) used for certain medical conditions (e.g. rheumatoid arthritis). |
| Cadmium and Selenium | Dimercaprol injection is not used as a treatment for these two metal poisonings. It can cause kidney damage. |
In addition to this list, tell your doctor about any other medications, herbal products, and vitamins you are taking.
What to expect during and after taking the medication
While you are receiving this medicine, your medical team will monitor your condition very closely . They will check your heart rate, blood pressure, and other vital signs regularly.
Sometimes, you may be asked to follow a special diet for a short time after taking this medicine. For example, you may be asked to eat foods that help change the pH of your body (to make urine alkaline). Your doctor will advise you on all of these things. Follow those instructions carefully.
What are the side effects?
Like any medicine, Dimercaprol injection can cause side effects. Some are minor, while others require immediate attention.
| Serious side effects that should be reported to the medical team immediately | |
|---|---|
| Allergic reactions | Skin rash, severe itching, swelling of the face, lips, tongue or throat. |
| Tightness or pain in the chest, throat, or arms | A sudden feeling of tightness or pressure. |
| High blood pressure | Sudden increase in blood pressure. |
| Changes in heart rate | Feeling like your heart is beating fast or irregularly. |
| Fever | Fever, especially in children. |
| Seizures | A situation like a fit. |
| Pain at the injection site | Severe pain or inflammation at the injection site. |
| Minor side effects that should be reported to the doctor if they persist or are bothersome | |
| Burning sensation | Feeling of burning in places like the lips, mouth, and throat. |
| Headache, nausea, vomiting | Common side effects. |
| Increased saliva and tears, runny nose | These are usually temporary. |
| Stomach pain | Feeling of discomfort in the stomach. |
If you experience any other unusual symptoms not mentioned in this list, please inform your doctor or nursing staff about them as well.
Take-Home Message
- Dimercaprol (BAL in Oil) is a specialized injection given only in a hospital for heavy metal poisoning such as arsenic, mercury, lead, and gold.
- Before receiving this vaccine, be sure to tell your doctor about all your medical conditions, allergies (especially peanut allergy), and other medications you are taking.
- This is not a medicine that can be purchased from a pharmacy and used at home, but is administered intramuscularly by a trained medical professional.
- Avoid taking iron pills or supplements completely during treatment.
- Be aware of possible serious side effects (e.g., allergies, chest pain, high blood pressure) when taking the medication. If you notice anything unusual , inform the medical staff immediately .
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