Pediatric fatality secondary to EDTA chelation

To the Editor:

In the introduction to our case report, we stated “We describe the inappropriate use of chelation therapy in an autistic child that resulted in a fatal outcome.”¹ We were very clear throughout the paper that the use of disodium EDTA for the management of autism was neither validated nor approved therapy. However, the manuscript was prepared and accepted for publication prior to the litigation that occurred in this unfortunate case. We were unaware of the information that Dr. Atwood published in his blogs related to this incident that state that the practitioner used the disodium EDTA intentionally.²,³ Therefore, it was conceivable that this was yet another example of a medication error that occurred with medications that have similar generic, commercial names and pharmacology (e.g., disodium EDTA vs. calcium disodium EDTA, Endrate® vs. Versenate®). Medication errors involving these agents have been reported, and it is important to create awareness of the differences between these agents to prevent medication errors.⁴

We disagree with Dr. Atwood's and Ms. Woeckner's characterization of the two agents: “We suspect that Drs. Baxter and Krenzelok would agree that there is a crucial pharmacologic difference between the two drugs.” Both are chelators and exchange either calcium or sodium for other cations. In the case of disodium EDTA, calcium is chelated. Whereas this does not occur with calcium disodium EDTA. There is a distinction between their affinity for cations, but the pharmacology is essentially identical.

Dr. Atwood (Scientific Review of Alternative Medicine) and Ms. Woeckner (Citizens for Responsible Care and Research) represent a journal and an organization (respectively) that promotes responsible patient care and examine alternative medicine practices. They have used their letter to the editor as a forum to promote their opinions. Our goal in publishing this case report was to describe a tragic fatality that occurred as a consequence of inappropriate therapy and, hopefully, to prevent similar medication misuse and errors from occurring in the future.