Lead Toxicity

Question 1

History / Risk Factors

Answer 1

Child <5 yo

sibling or playmate with LT?

Living near consruction sites, hazardous waste dumps?

Pica

associated with trade i.e. plumbers, pipefitters, welders, firing ranges workers, painters?

symptoms: Abd pain, irritability, lethergy, fatique, myalgia, paresthesia, learning disorder.

Moderte Symptoms: constipation, diffuse abdominal pain, headaches, jloss of libido, tremor, vomiting, weight loss.

PMH: Mother FT pregnancy, no complications, Breast fed untill age 1, Walked age 1 toilet trained age 16 18 months, sat up 6 months, immunizations upt to date. No surgeries, No major illnesses.

SH: Father plumber, lives in sf home wit both parents, mother works as hostess, babsitter for patient 5x week. possible child plays with lead fittings.

Severe sx: abd colic, metal taste in mouth, coma, encephalopathy, lead lines, wrist drop, oliguria, renal failure, seizure.

Question 2

Physical

Answer 2

ENT: sclera / conjunctiva clear, funduscopic normal,

No thyromegaly,

Heart: RRR no g/r/m

Chest: CTAB, No CVA tenderness

Abdomen: NT, no masses

Skin: Pink, no lesions, No lead lines

Question 3

Dx

Answer 3

Sx consistant with lead toxicity

Question 4

Plan

Answer 4

Labs: Serum BLL, CBC, CMP

Medications: Iron and viatmin C

POssible Chemet 10 mg / kg iv

Referral to ER if sever

Report to Dept. of Public Health If levels >45

Education: exposure risks, health risks, treatments,

RTC 3 days or if symptoms worsen or go to ER.