How is lead toxicity treated in children?

Updated: Jan 16, 2020
  • Author: Pranay Kathuria, MD, FACP, FASN, FNKF; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

Recommended actions based on BLLs are provided below. [30] Capillary BLL levels need to be confirmed with venous blood draws. The urgency of the confirmation is dependent on the BLL. Levels of 40–59 µg/dl require confirmation in 48 hrs, BLLs between 60 and 69 µg/dl require confirmation in 24 hrs, and higher levels require immediate confirmation.

BLL < 5 µg/dL

Share results with family. Perform routine assessment of nutritional, physical, and mental development and assess risk factors for iron deficiency. Families should be provided with anticipatory guidance about common sources of environmental lead exposure. Repeat BLL in 6–12 months if the child is at high risk for lead exposure or if risk profile increases. For children initially screened before 12 months of age, consider retesting in 3–6 months for children at high risk.

BLLs between 5 and 9 µg/dL

Routine assessment of nutritional and developmental milestones, environmental assessment to identify potential sources of lead exposure, and nutritional counseling related to calcium and iron intake and have follow up BLLs. 

BLLs between 10 and 19 µg/dl

A home visit to identify potential sources of lead exposure in addition to the above are required. Consider checking blood iron levels and repeat BLLs within 3 months.

BLLs between 20 and 44 µg/dl

In addition to the above, patients require neurodevelopmental assessment, assessment of blood iron levels, and abdominal X-rays with bowel decontamination if indicated. Patients with BLL 20–24 µg/dl should have BLL checked in 1 to 3 months. If BLL is between 25 and 44 µg/dl, then retesting must be done within one month.

BLLs ranging from 45 to 69 µg/dl

Such levels warrant medical treatment with oral chelation therapy and environmental assessment and remediation within 48 hours. If a lead-safe environment cannot be assured, then the subjects should be hospitalized.

BLLs greater than 70 µg/dL

These levels are considered medical emergencies, regardless of whether neurologic symptoms are present. The risk of encephalopathy is high and treatment is required. However, lead levels should be reviewed in the context of the clinical examination and history. For example, a child may swallow a lead foreign body, show a documented BLL higher than 70 µg/dL within 2 days, and still have a low total-body burden (the lead would be predominantly within the blood compartment in this scenario). Encephalopathy would not be expected in this scenario. However, a child who chronically ingests lead paint dust may have a lower BLL but a much higher total-body burden and may subsequently exhibit neurologic findings (in this scenario, the lead has had time to redistribute amongst all the compartments).


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