Lead Screen/Toxicity/Treatment


When to start Screening?
- Starts @ 12 Months unless indication to test early.
- Venous sample used to measure lead level
- Normal < 10
Lead poisoning:
  • S/S: Anorexia, decreased activity, irritability, vague abd. pain & insomnia.
  • Test: CBC, Serum iron & ferritin, Retic count. Lead level 

BLL
(microg/dL)
     Treatment actions
<44 <10 Provide lead education and regular developmental/behavioral surveillance
Reassess or re-screen in 1 year, or sooner if the child is younger than two years, was tested at the onset of warm weather, is at high risk for lead exposure, or the exposure sources have changed
 
10-14 Provide lead education and regular developmental/behavioral surveillance
Provide follow-up testing within one month, then q3-4 months
Perform history, physical, and laboratory examinations (CBC, urinalysis, BMP, glucose, BUN, creatinine, LFT).
Can use DMSA or d-penicillamine but not evidence-based
 
15-19 Provide lead education and regular developmental/behavioral surveillance
Provide follow-up testing within 1 month, then q3-4 months
Refer to social services
Initiate professional environmental cleanup
Follow guidelines for 20-44 g/dL if BLL remains ≥15 microg/dL (on two samples obtained at least three months apart)
 
20-44 Provide lead education and regular developmental/behavioral surveillance
Refer to clinical center specializing in lead poisoning
Provide case management
Provide both clinical and environmental management
Ensure lead hazard control
Consider treating with DMSA
 
45 - 69 Provide lead education
Refer to clinical center specializing in lead poisoning
Provide coordination of care
Provide diagnostic testing within 24 to 48 hours
Perform clinical evaluation and management within 48 hours
Provide appropriate chelation therapy
Perform aggressive environmental intervention
Provide follow-up testing at least once per month (in accordance with chelation therapy) and regular developmental/behavioral surveillance
continuous IV EDTA
or
PO DMSA (a derivitive of dimercaprol)
≥70 MEDICAL EMERGENCY --> Hospitalize
Perform diagnostic testing immediately (samples shouldbe processed emergently)
Hospitalize immediately and begin chelation therapy
Begin other activities as above
IV EDTA and IM Dimercaprol

BLL =  Blood Lead Level

Treatment

Venous BLL 5-14 mcg/dL

Venous lead level 5 -14 mcg/dL
1. Report to appropriate health authorities
2. Repeat lead level in one month, then every three to four months until <5 mcg/dL (0.24 micromol/L)
3. Provide parents with educational and nutritional counseling

Venous BLL 15-19 mcg/dL

Venous lead levels 15-19 mcg/dL
1. Report to appropriate health authorities
2. Perform history, physical examination, and laboratory examinations (CBC, urinalysis, BMP, glucose, BUN, creatinine, LFT).
3. Repeat lead level in 1 month,
Then q 3-4 months until <5 mcg/dL.
If the lead level is not <15 mcg/dL (0.72 micromol/L) with the second or third testing, refer for environmental abatement
4. Provide parents with educational and nutritional counseling

Venous BLL 20-44 mcg/dL

Asymptomatic patients with venous lead level 20-44 mcg/dL
1.     Report to appropriate health authorities.
2. Perform history, physical, and laboratory examinations (CBC, urinalysis, BMP, glucose, BUN, creatinine, LFT).
3. Chelation is not suggested for children with lead levels < 45 mcg/dL (2.17 micromol/L).*
4. Provide parents with educational and nutritional counseling.
5. Monitor lead level q 2 weeks x 3,
Then repeat q 1 Month x 3-4,
Then q 3-4 Months  x1 yr.
*Continue to check lead levels until <30 mcg/dL (1.45 micromol/L).

Follow Up

Schedule for follow-up blood lead testing in infants
Venous BLL
(µg/dL)
Early follow-up
(first 2-4 tests after identification or until BLL begins to decline)
Later follow-up
(after BLL begins to decline)
<10 According to local lead screening guidelines for children According to local lead screening guidelines for children
10-14 3 months Within 6-9 months
15-19 1-3 months Within 3-6 months
20-24 1-3 months Within 1-3 months
25-44 2 weeks-1 month Within 1 month
≥45 Within 24 hours As directed by clinician managing chelation treatment

 

 

 

SOURCE: uptodate.com