Managing childhood lead poisoning
Markowitz, M.E.
Salud Publica de Mexico 45(Suppl 2): S225-S231
2003
ISSN/ISBN: 0036-3634 PMID: 14746008 Document Number: 560382
This paper reviews the clinical management of children with lead poisoning. A first step is to define the measures to be used in their assessment and be aware of the limitations. Measurements of blood lead levels can be made on anticoagulated whole blood samples using either: atomic absorption spectroscopy or anodic stripping voltametry. However a more accurate method is fluorescent RX'ray of the skeleton or systematic biochemical tests of lead levels in urine. Remedies include elimination of lead in the environment, changes in children's behavior and dietary checks for adequate calcium and iron intake. Chelation therapy, using Ca edetate and succimer eliminates lead from the skeleton, which is then quickly excleted using a cathartic to help prevent re-absorption. Chelation may save lives where BLLs are very high. There is usually a short term reduction of BLLs with a subsequent rise. Serious cases may require repeat therapies. Chelation should be considered in children with BLLs > = 45 micrograms/dl. Chelation therapy reduces BLLs and associated symptoms. However cognitive decline may be irreversible, indicating that emphasis should be on prevention rather than cure. The English version of this paper is available at: http://www.insp.mx/salud/index.html.