Gadolinium Deposition Disease (GDD) is a condition reported in individuals following exposure to gadolinium-based contrast agents (GBCAs) used in MRI procedures. Symptoms typically manifest within hours to a month after exposure and can vary among individuals. Commonly reported symptoms include:
-
Neurological Symptoms: Patients often experience cognitive difficulties, commonly referred to as “brain fog,” which encompasses memory problems, confusion, and difficulty concentrating. Headaches, dizziness, and balance issues have also been reported.
-
Skin-Related Symptoms: Individuals may report persistent or painful skin thickening, burning or itching sensations, patches of discoloration, and a “pins and needles” sensation in the extremities.
-
Musculoskeletal Issues: Joint pain, stiffness, and muscle pain are frequently observed, potentially affecting multiple areas of the body and leading to reduced mobility.
-
Systemic Symptoms: Fatigue, weakness, and a general feeling of malaise are common. Some individuals also experience gastrointestinal disturbances, such as nausea, abdominal pain, and bowel irregularities.
Treatment of GDD
Chelation is the preferred treatment to remove gadolinium from the body. Chelation therapy involves the administration of agents that bind to heavy metals, facilitating their removal from the body. One such agent, diethylenetriaminepentaacetic acid (DTPA), is best at binding to gadolinium. DTPA forms stable complexes with gadolinium, promoting its excretion through the kidneys.
DTPA Chelation Protocol for Gadolinium
Chelating agents Ca-DTPA and Zn-DTPA are salts of diethylentriamenepentaacetate (DTPA) and are FDA approved for the chelation of plutonium, americium, and curium. They are also strong chelators of Gadolinium (Gd).
DTPA is extremely safe, and because of this it is widely used in medicine as the basic ligand for the MRI contrast dye Magnevist in which over 100 million doses have been given worldwide to date, and also for the nuclear agent Tc-DTPA. It is used because of its safety and stability with the metal. The ligand is the safe part of the molecule.
Ca-DTPA is more effective than Zn-DTPA in the first 24 hours after exposure because it removes radioactive elements more efficiently. Zn-DTPA is preferred for long-term use due to a reduced risk of depleting essential minerals.
2 Day Standard protocol
Day 1
- Seat patient in reclining chair, in seated upright position
- Start IV with 1 liter NS and plan to run over 1 hour
- Inject 2.5mL of Ca-DTPA IV over 1 minute
- After 40 minutes have patient recline with legs up
- After 50 minutes inject remaining 2.5mL Ca-DTPA IV over 1 minute
Day 2 repeat same steps as Day 1 with Zn-DTPA. Repeat the 2-day protocol every 3 weeks
Gentle protocol
- Zn-DTPA chelation only
- Mix 5mL ZN-DTPA in 1 liter NS
- Run 1 liter NS over 2 hours
- Repeat every 1 week
Rational for hand push is to simulate the dynamic injection of the GBCA to begin with – that is to chase down the GBCA as it was administered. Drip infusion may not penetrate deeply enough into organs and interstitial tissues.
Rationale for split dose is to decrease the flare response of one large 5ml dose at once. The second split dose removes Gd that was loosened but not removed by the first split dose (theory). So this is a double chelation in one sitting.
Side Effects:
- Mild side effects include nausea, vomiting, diarrhea, and metallic taste.
- Ca-DTPA can deplete essential minerals, so supplementation may be needed if used for extended periods.
