Lead Toxicity

Pt with h/o immigration from developing nation presents with subacute abdominal pain, irritability, lethargy. Parents report milestone regression and are concerned about possibility of ADHD. Pt lives in house built before 1970. HTN on exam.

• CBC shows microcytic anemia; peripheral smear shows basophilic stippling

• Obtain serum ferritin, TIBC to r/o iron deficiency anemia

• Lead level

  • 5-14 mcg/dL: Repeat lead level to confirm result

  • 15-44 mcg/dL: Obtain abdominal x-ray and perform whole bowel irrigation if suspected lead particles present

  • 45-69 mcg/dL: Repeat level within 48 hours and administer DMSA 10 mg/kg/dose TID x 5 days and then BID x 14 days. Provide nutritional supplementation with MVT with iron and 2 8oz glasses milk.

  • 70 mcg/dL or greater: Emergency consultation advised; contact regional poison control center (1-800-222-1222)

• Parents counseled about routes and risks of lead exposure

• Parents advised screen all children living in the household for lead

• Health department notified