Lead Poisoning

CDC Recommendations on Prevention and Management of High Blood Lead Levels in Children - Practice Guidelines

A Toddler with Constipation, Anemia, and Abnormal Radiographic Findings - Photo Quiz

Lead Poisoning in Children - Article

ABSTRACT: The prevalence and severity of childhood lead poisoning have been greatly reduced since the removal of lead from paint and gasoline in the 1970s. Despite these efforts, approximately 310,000 U.S. children younger than five years have elevated blood lead levels. Health care professionals should perform targeted screening for lead poisoning in children who are Medicaid-enrolled or -eligible, foreign born, or identified as high risk by the Centers for Disease Control and Prevention (CDC) location-specific recommendations or by a personal risk questionnaire. Venous sampling is the preferred method for measuring blood lead levels, but a carefully collected finger-stick sample is an acceptable alternative. Capillary samples of elevated levels should be confirmed by a venous sample. The CDC recommends that the threshold for follow-up and intervention of lead poisoning be a blood lead level of 10 µg per dL or higher. Recommendations for treatment of elevated blood levels include a thorough environmental investigation, laboratory testing when appropriate, iron supplementation for iron-deficient children, and chelation therapy for blood lead levels of 45 µg per dL or more. Prevention consists of education and avoidance of lead-contaminated products.

Occupational Lead Poisoning - Article

ABSTRACT: The continued occurrence of occupational lead overexposure and lead poisoning in the United States remains a serious problem despite awareness of its adverse health effects. Lead exposure is arguably the oldest known occupational health hazard. It is a particularly insidious hazard with the potential for causing irreversible health effects, including hypotension, central nervous system problems, anemia and diminished hearing acuity before it is clinically recognized. Scientific evidence of subclinical lead toxicity continues to accumulate, making further reduction in workplace exposure, regular screening, and earlier diagnosis and treatment of critical importance in the prevention of this occupational hazard. For the most part, the diagnosis of lead poisoning in the adult worker is based on the integration of data obtained from the history, a physical examination, laboratory tests and tests of specific organ function. A blood level of 40 micrograms per dL (1.95 mumol per L) or greater requires medical intervention; a level of 60 micrograms per dL (2.90 mumol per L) or three consecutive measurements averaging 50 micrograms per dL (2.40 mumol per L) or higher indicate the necessity for employee removal. The decision to initiate chelation therapy is not based on specific blood levels but depends on the severity of clinical symptoms.

Primary Care of International Adoptees - Article

ABSTRACT: International adoptees are presenting to family physicians with increasing frequency. U.S. citizens have adopted over 100,000 international children since 1979. Prospective parents may seek advice from their physician during the adoptive process. If available at all, medical information on the child is often scanty. History and physical examination alone are often insufficient for diagnosis of common problems in this population. Adoptive parents may have concerns about growth and development, and appropriate immunizations. In addition, bacterial, viral and parasitic infections endemic in countries of origin create unusual challenges for the U.S. primary care physician. A basic understanding of the process of international adoption, a skillful evaluation of the child and selected laboratory studies enable the family physician to support the prospective parents and assist in a smooth transition of the child into a new family.

Lightening the Lead Load in Children - Article

ABSTRACT: More than 4 percent of preschool-aged children in the United States have blood lead levels above 10 microg per dL (0.50 pmol per L), and these levels have been associated with a decline in IQ. The Centers for Disease Control and Prevention advocates the use of a screening questionnaire to identify lead exposure or toxicity in all children. Primary prevention through the removal of lead from gasoline and paint has led to a reduction of blood lead levels in children. Secondary prevention through paint hazard remediation is effective in homes that have a high lead burden. Children with lead levels of 45 to 69 microg per dL (2.15 to 3.35 pmol per L) should receive chelation therapy using succimer (DMSA) or edetate calcium disodium (CaNa2EDTA). Use of both CaNa2EDTA and dimercaprol (BAL in oil) is indicated in children with blood lead levels higher than 70 microg per dL (3.40 micromol per L). Current treatment recommendations are based on the reduction of blood lead levels, which may not represent a significant overall reduction of the lead burden. Clinical trials of existing agents are needed to determine patient-oriented outcomes, such as the effect on IQ.

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