Lead toxicity with a new focus Flashcards
Symptoms of acute/subacute lead toxicity?
headache, clumsiness, somnolence, stupor, seizure abdo pain, constipation, vomiting, anemia, renal failure possible death
Symptoms of low-level lead exposure?
cognitive delay, neurodevelopmental signs (inattention, hyperactivity, hearing impairment, poor balance, speech delay)
3.5% of mild intellectual disability worldwide is caused by lead exposure
Long-term consequences of lead exposure
HTN, vascular disease
renal impairment
aberrant behaviour
Where is lead stored in body?
Bones (70%)
What is half-life of lead in RBC?
45 days
Who to consider lead level testing in?
HELP(d)
- Home built before 1960 (lived in home sometime in past 6 mo), esp when water supplied by lead piping or original paint present, peeling or chipped
- Emigrated or adopted from country/region with higher population lead levels
- Lead poisoning hx in sibling, housemate, playmate
- Pica or eaten paint chips, tend to mouth painted surfaces
- neuroDevelopmental disorder and any of the above RF
Other RF:
African/American
low SES
Poor nutrition (shared absorptive pathways cause children with mineral deficiency to absorb more lead (ca, iron, zinc)
Testing when high lead level is suspected?
CBC
Ferritin
Blood lead level (venous)
Calcium, protein, albumin
What are the components of the pediatric environmental health history (for lead exposure)?
Home/child care/school
- neighborhood established in 1960s or before
- Buildings constructed in 1980s or earlier
- Building of poor state of repair
- Proximity to past industrial or waste site
- Proximety to busy roadway or airfield (<30 yards)
Food
- imported sugar, candy, baking supplies
- food containers of pewter or ceramic
- Foods that may accumulate lead
- wild game shot with lead bullet
Consumer products
- costume jewelry
- candles
- Imported painted items - toys, crayons, mini-blinds, vinyl items, reusable bags
- Cosmetics
Occupation and hobby related
- battery manufacturing and recycling
- radiator repair, welding
- lead mining & smelting
- brass & bronze foundry work
- demolition & renovations
- hunting, marksmanship, military
- pottery glazing
- leaded glass
Family factors
- mother exposed to lead in pregnancy
- previously lived in country with high population lead levels
- sibling/other contact with lead exposure
How to manage child with lead toxicity?
- 5-14 mcg/dL
- review lab test with family
- Retest venous BLL at 1-3 mo (if stable or decreasing, retest in 3 mo)
- PEHH. Provide preliminary advice about reducing or eliminating exposure sources
- Contact local public health
- routine health maintenance: neurodevelopmental screening, assess nutrition
- Nutrition counselling on Ca and iron.
- Vitamin-C containing foods (fruits) with iron
- encourage iron rich foods
- Do CBC, ferritin, CRP and treatment
- consider multivitamin
- Complete full neurodevelopmental assessment & follow up —> effects may manifest over years
- 15-44 mcg/dL
- Perform above
- confirm BLL with repeat at 1-4 wk
- Consider AXR
- consider gut decontamination if ingested foreign body. Call local poison centre for help.
- Chelation not typically recommended
- > 44 mcg/dL
- follow above
- repeat venous test at 48 hours
- Consider hospitalization/chelation therapy in consultation with Poison control centre.