Lead toxicity with a new focus

Question 1

Symptoms of acute/subacute lead toxicity?

Answer 1

headache, clumsiness, somnolence, stupor, seizure
abdo pain, constipation, vomiting, 
anemia, 
renal failure
possible death

Question 2

Symptoms of low-level lead exposure?

Answer 2

cognitive delay, neurodevelopmental signs (inattention, hyperactivity, hearing impairment, poor balance, speech delay)

3.5% of mild intellectual disability worldwide is caused by lead exposure

Question 3

Long-term consequences of lead exposure

Answer 3

HTN, vascular disease
renal impairment
aberrant behaviour

Question 4

Where is lead stored in body?

Answer 4

Bones (70%)

Question 5

What is half-life of lead in RBC?

Answer 5

45 days

Question 6

Who to consider lead level testing in?

Answer 6

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)

Question 7

Testing when high lead level is suspected?

Answer 7

CBC
Ferritin
Blood lead level (venous)
Calcium, protein, albumin

Question 8

What are the components of the pediatric environmental health history (for lead exposure)?

Answer 8

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

Question 9

How to manage child with lead toxicity?

Answer 9

• 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.