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Study Notes Pediatrics

Study Notes Pediatrics


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Published by MedShare
Study Notes Pediatrics
Study Notes Pediatrics

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Published by: MedShare on Apr 01, 2010
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* 24mo has a lead level of 19 on a routine screening for a well-child check. The patient is asymptomatic but lives in
a historic home being renovated by the parents.
* Lead poisoning is a chronic disorder often seen in children near environmental exposure risks such as old houses
being restored or old houses with paint chips. New houses do not have lead in the paint.
* Other sources of lead include pottery, plates, fishing weights, aerosolized from stripping pain in old homes, lead
pipes, lead-glazed pottery with folk remedies.
* A good source of dietary iron is using iron-based skillets (joke). Lead-glazed pottery will put lead in food.
* A majority of patients are found on routine screening and many will be asymptomatic.
* Anorexia, apathy, lethargy, anemia, decreased play activity, aggressiveness, poor coordination, poor school
performance, are symptoms of lead intoxication. Encephalopathy or coma with acute active ingestion.
* Chronic lead exposure can cause apathy, clumsiness, nausea, vomiting.
* Diagnosis is via blood-lead level, gold standards. Best test is not free erythrocyte protoporphyrin.
* Levels greater than 10 are considered abnormal.
* CBC may reveal anemia, basophilic stippling. X-ray will show lead lines at joints (metacarpals, knee).
* Treatment is to remove child from the environment.
* Lead > 15-19 then screen q4mo, > 20 then confirm with venous blood, >45 begin medication treatments, >55-69
treatment is EDTA or succimer (oral chelating agent), > 70 is EDTA and dimercaprol (BAL, British Anti-Lewisite).
* Dimercaprol is mixed with peanut oil (BAL in oil) so ask about peanut allergy.
* Usually seen in children < 3yo, encephalopathy can occur after 3-6 weeks of active lead ingestion.


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