CDC reference value (2021) = 3.5 mcg/dL. Universal screening at 12 and 24 mo (or per state Medicaid policy). Chelate based on BLL: < 45 — environment + nutrition; 45–69 — DMSA (succimer); ≥ 70 or encephalopathy — BAL + EDTA inpatient.
🚩 Red-flag clues (must not miss)
- •Lead encephalopathy: AMS, seizures, vomiting, papilledema → BAL + EDTA + cerebral edema mgmt
- •Pica + microcytic anemia + basophilic stippling = lead
- •Source: pre-1978 paint, imported pottery, traditional remedies (azarcón, greta), industrial parent
Labs
- Venous blood lead level (capillary screen confirmed venous)
- CBC (microcytic, basophilic stippling), iron studies
- BMP (renal), Ca, Mg, Phos
- KUB if ingestion / radiopaque foreign body (lead paint chips)
Imaging
- KUB — lead lines on long-bone metaphyses (chronic), GI lead chips
Differential & next step
| Diagnosis | Clue | Next step |
|---|---|---|
| BLL < 5 mcg/dL | — | Routine; counsel on environmental sources |
| BLL 5–14 | — | Repeat in 1–3 mo; environmental + nutritional counseling |
| BLL 15–44 | — | Public health referral, environmental investigation, abdominal XR if pica |
| BLL 45–69 (asymptomatic) | — | DMSA (succimer) 10 mg/kg PO q8h × 5 d, then q12h × 14 d |
| BLL ≥ 70 OR encephalopathy | — | Admit. Dimercaprol (BAL) 75 mg/m² IM q4h + CaNa₂EDTA 1500 mg/m²/day IV cont infusion × 5 d |
Medications & dosing
| Drug | Dose | Notes |
|---|---|---|
| Succimer (DMSA, Chemet) | 10 mg/kg PO q8h × 5 d, then q12h × 14 d | Outpatient if reliable; can repeat course |
| Dimercaprol (BAL) | 75 mg/m² IM q4h × 5 d | Painful (peanut oil); contraindicated in G6PD; give BEFORE EDTA in encephalopathy |
| CaNa₂EDTA | 1500 mg/m²/day IV continuous × 5 d | Hydrate; monitor renal function |
Management / next steps
- Remove from source; do NOT discharge to lead environment
- Iron, calcium, vitamin C supplementation (↓ absorption)
- Whole-bowel irrigation if radiopaque GI lead
- Public health reporting; sibling screening
Source: https://fprmed.com/fprmedcom/Pages/Pedi/pedilead.html
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