Lead Screening/Lead Poisoning

Question 1

what is important to remember about a finger stick screening for lead?

Answer 1

can be falsely high due to skin contaminant; do a serum level to confirm

Question 2

When is chelation therapy used for lead poisoning?

Answer 2

for blood levels > 45mcg/dL

Question 3

Why is chelation therapy used?

Answer 3

promotes lead excretion from GI tract

Question 4

Name 3 options for chelation therapy

Answer 4

BAL: British anti-Lewisite **
Calcium disodium EDTA **
succimer

**after BAL or calcium disodium EDTA, use polyethylene glycol to irrigate bowels; continue until abdominal x-ray shows no abnormalities

Question 5

Route/dosing for chelation therapy

Answer 5

BAL: IM
Calcium disodium EDTA: IV
succimer: PO

Question 6

What is the “rebound phenomenon”?

Answer 6

circulating lead in blood is small portion of total body burden; lead levels may rebound after chelation therapy; pt may need several cycles

Question 7

What blood issue puts a child at risk for increased absorption of lead? How to mitigate risk?

Answer 7

iron deficiency anemia

supplement iron to decrease GI absorption of lead

Question 8

What organs to watch with chelation therapy?

Answer 8

kidneys: lead and calcium disodium EDTA are toxic to kidneys
brain: lead is neurotoxic; watch for seizures

Question 9

neurocognitive effects of lead exposure

Answer 9

developmental delays
lower IQ scores
speech/language problems
visual/motor problems
learning disabilities
academic challenges

Question 10

behavioral challenges with lead exposure

Answer 10

aggression
hyperactivity
impulsivity
delinquency
disinterest
withdrawal