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Contraindications & Precautions Absolute Contraindications Known hypersensitivity to DMPS or sulfur-containing chelators Severe renal impairment (risk of accumulation and toxicity) History of Stevens-Johnson syndrome from sulfur-related drugs Uncontrolled asthma or severe atopy (higher risk of anaphylactic reactions) Relative Contraindications G6PD deficiency (risk of hemolysis) Pregnancy (unless life-saving toxicology situation) Breastfeeding Cardiovascular instability Toxicology-Specific Precautions Must ensure adequate hydration and renal perfusion Must monitor urine output , creatinine, BUN Correct electrolyte abnormalities Use caution in patients with metal implants (low risk but theoretical binding) IV-Specific Precautions Infuse under monitoring (BP, HR, respiratory status) Avoid rapid bolus Use sterile pharmaceutical-grade DMPS only Interactions A

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In addition to the regulation of the acidic state of the TME, targeting lactate-related signals should also be a focus of attention