Pediatric Lead Toxicity Workup

  • Author: Mohamed K Badawy, MD, FAAP; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 8, 2011
 

Approach Considerations

Perform a rapid bedside glucose determination in children who present with altered mental status. Obtain serum pH and electrolyte levels, including calcium, magnesium, and phosphorus. Check for anion gap acidosis that may be present in co-ingestions.

A complete blood count (CBC) may reveal hypochromic microcytic anemia. Basophilic stippling of the erythrocytes, which is characteristic of lead poisoning, is uncommon in children.

Perform urinalysis. Children may appear mildly dehydrated, with concentrated urine and poor appetite. This can signal the beginning of the development of inappropriate secretion of antidiuretic hormone.

Whole blood lead level

Whole blood lead level (BLL) is the criterion standard for confirming the diagnosis of lead poisoning. A BLL of 10 mcg/dL or higher denotes poisoning. For convenience, a fingerstick capillary lead level has been used for screening. Properly collected capillary samples have a 10% false-positive rate. Once an elevated lead level is detected, a venous lead level is assessed for confirmation.

Erythrocyte protoporphyrin

Erythrocyte protoporphyrin (EP) may be obtained in selected patients. Lead toxicity affects heme synthesis at several steps; this includes interference with the enzyme ferrochelatase, leading to the accumulation of EP. EP is easily detected because it fluoresces easily. EP is an adjunct for the diagnosis in the presence of elevated lead levels of 55 mcg and higher. At lead levels below that, EP is not a very sensitive measure, and its positivity declines. Therefore, EP is not used as a primary screening tool.

Hair samples

In Russia, hair sample is the standard for lead poisoning screening. However, studies have demonstrated that blood lead specimens are more sensitive than hair samples in detecting lead exposure.

Next

Imaging Studies

Abdominal radiography

Presence of radiopaque flakes is a clear indicator of pica.

Long-bone radiography

Radiodensity may be detected at the distal metaphyseal area. These indications, known as lead lines, are true growth arrest lines and, although not pathognomonic, are associated with chronic lead exposure.

Chest radiography

This study is indicated in patients with lead encephalopathy to confirm the position of the endotracheal tube. Although radiographic findings of suspected aspirations may be initially absent, an initial radiograph is often helpful.

CT scanning

Head computed tomography (CT) scanning may be needed in patients who present with altered mental status to exclude cerebral edema and structural lesions.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mohamed K Badawy, MD, FAAP  Assistant Professor of Emergency Medicine and Pediatrics, University of Texas Southwestern Medical School; Associate Medical Director, Division of Emergency Medicine, Children's Medical Center

Mohamed K Badawy, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory P Conners, MD, MPH  Chief, Division of Emergency Medical Services, Children's Mercy Hospital; Vice Chair of Pediatrics for Emergency and Urgent Care; Professor of Pediatrics and Emergency Medicine, University of Missouri-Kansas City School of Medicine

Gregory P Conners, MD, MPH is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Pediatric Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Murata K, Iwata T, Dakeishi M, Karita K. Lead Toxicity: Does the Critical Level of Lead Resulting in Adverse Effects Differ between Adults and Children?. J Occup Health. Nov 6 2008;[Medline].

  2. American Academy of Pediatrics Committee on Environmental Health. Lead exposure in children: prevention, detection, and management. Pediatrics. Oct 2005;116(4):1036-46. [Medline]. [Full Text].

  3. American Academy of Pediatrics Committee on Environmental Health. Lead. In: Handbook of Pediatric Environmental Health. American Academy of Pediatrics. Elk Grove, IL: AAP; 1999:131-43.

  4. Canfield RL, Henderson CR Jr, Cory-Slechta DA, et al. Intellectual impairment in children with blood lead concentrations below 10 microg per deciliter. N Engl J Med. Apr 17 2003;348(16):1517-26. [Medline].

  5. Koller K, Brown T, Spurgeon A, Levy L. Recent developments in low-level lead exposure and intellectual impairment in children. Environ Health Perspect. Jun 2004;112(9):987-94. [Medline].

  6. CDC. Preventing Lead Poisoning in Young Children. CDC, United States Department of Health and Human Services:1991. [Full Text].

  7. CDC. Screening Young Children for Lead Poisoning. Guidance for State and Local Public Health Officials. Atlanta, GA: United States Department of Health and Human Services; 1997:[Full Text].

  8. Lanphear BP, Winter NL, Apetz L, Eberly S, Weitzman M. A randomized trial of the effect of dust control on children's blood lead levels. Pediatrics. Jul 1996;98(1):35-40. [Medline].

  9. Lanphear BP, Hornung R, Ho M. Screening housing to prevent lead toxicity in children. Public Health Rep. May-Jun 2005;120(3):305-10. [Medline].

  10. Rogan WJ, Dietrich KN, Ware JH, et al. The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Engl J Med. May 10 2001;344(19):1421-6. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.