Lead Toxicity

Recommended Follow-up Services According to Blood Lead Level (BLL)

In brief: 10, 20, 45, 70.

* below 10, no action
* below 20, confirmatory level and repeat testing
* Above 20, refer to department of health for environmental investigation and referral for support
* Above 45, outpatient chelation
* Above 70, hospitalize

Succimer (DMSA) -- In January 1991, became the only drug approved by the FDA specifically for lead chelation in children and the only drug approved to treat a specific laboratory test, a lead level higher than 45 mcg/dL (2.17 mmol/L). Has been shown to be an effective oral chelator that produces plumburesis, approaching that of the combination of CaNa2EDTA and BAL. Although never a substitute for careful environmental controls, produces a rapid decline in lead level and reverses many of the biochemical indicators of toxicity. Not currently licensed for use in adults. Although experience suggests that it is safe and effective, its use must be considered carefully. Adults exposed from an occupational source must be carefully excluded from further exposure.

<10 (mcg/dL)

* No action required

10-14

* Obtain a confirmatory venous blood lead level within 1 month; if still within this range, provide education to decrease blood lead exposure
* Repeat blood lead level test within 3 months.

15-19

* Obtain a confirmatory venous blood lead level within 1 month; if still within this range, take a careful environmental history
* Provide education to decrease blood lead exposure and to decrease lead absorption
* Repeat blood lead level within 2 months.

20-44

* Obtain a confirmatory venous blood lead level within 1 week; if still within this range, conduct a complete medical history (including an environmental evaluation and nutrition assessment) and physical exam.
* Provide education to decrease blood lead exposure and to decrease lead absorption
* Either refer the patient to the local health department or provide case management that should include a detailed environmental investigation with lead hazard reduction and appropriate referrals for support services
* If blood lead level is >25 mcg/dL, consider chelation (not currently recommended for blood lead levels <45 mcg/dL), after consultation with clinicians experienced in lead toxicity treatment.

45-69

* Obtain a confirmatory venous blood lead level within 2 days; if still within this range, conduct a complete medical history (including an environmental evaluation and nutrition assessment) and physical exam
* Provide education to decrease blood lead exposure and to decrease lead absorption
* Either refer the patient to the local health department or provide case management that should include a detailed environmental investigation with lead hazard reduction and appropriate referrals for support services
* Begin chelation therapy in consultation with clinicians experienced in lead toxicity therapy.

>70

* Hospitalize the patient and begin medical treatment immediately in consultation with clinicians experienced in lead toxicity therapy
* Obtain a confirmatory blood lead level immediately
* The rest of the management should be as noted for management of children with blood lead levels between 45 and 69.

Lane WG, Kemper AR. American College of Preventive Medicine Practice Policy Statement. Screening for elevated blood lead levels in children. Am J Prev Med 2001 Jan;20(1):78-82. [40 references]
eMedicine.com: http://www.emedicine.com/EMERG/topic293.htm Toxicity, Lead
Last Updated: October 4, 2004

Home/Furnishings

• buildings built before 1950
  • with peeling or chipping paint, including day care centers, preschools, babysitter homes
  • with recent or undergoing renovation
• buildings built before 1978 with recent renovation
• live within one block within a major highway or busy street
• live near active lead smelter, battery recycling plant
• mini-blinds made outside U.S. before 1996

Cooking/Eating

• use hot tap water for cooking or drinking
• use pottery,ceramics for cooking, eating, drinking
• eat paint chips, soil, dirt
• home remedies like azarcon, greta, pay looah, tamarind

Exposures

• playmate with high lead level >15, being treated for lead poisoning
• contact with adult who with occupational exposure: constructions, welding, pottery...

Other: Have you ever been told your child has low iron?

'Yes' to one question requires lead testing.

AAP. Guidelines for Health supervision III.