CHOICE OF MEDICAL MANAGEMENT BASED ON SYMPTOMS AND BLOOD LEAD CONCENTRATION
Guidelines for the Detection and Management of Lead Poisoning for Physicians and Health Care Providers, Revised 1996
ASYMPTOMATIC CHILDREN
(Before treatment, measure venous blood for lead)
Clinical Presentation
BLL 10 to 14 mcg/dL
BLL 15 to 19 mcg/dL
BLL 20 to 39 mcg/dL
Treatment
F
Comments
Pediatric evaluation
Monitor blood lead levels 3-6 mo.
Screen for iron deficiency anemia
Provide counseling regarding appropriate nutrition and cleanlinessremoval of paint chips and dust.
Pediatric evaluation
Monitor blood lead levels at one month
Screen for iron deficiency anemia
Refer to local health department for environmental investigation and
public Health Nurse Visit
Provide counseling regarding appropriate nutrition and cleanliness—
removal of paint chips and dust.
Succimer
BLL 40 to 69 mcg/dL
Pediatric evaluation
Monitor blood lead levels
Screen for iron deficiency anemia
Succimer: 10mg/kg/dose or 350
mg/m2/dose orally every 8 hours for 5
days. Reduce to 10 mg/kg/dose or 350
mg/m2/dose every 12 hours for an
additional two weeks. Monitor liver
function.
Or
CaNa2EDTA 1000 mg/m2/day
Hospitalize when symptoms are present.
>50 mcg/dL
BLL >70 mcg/dL
Pediatric evaluation
Monitor blood lead levels
Screen for iron deficiency anemia
Hospitalization.
Some clinicians use succimer. (FDA approved with blood lead levels
>45 mcg/dL). Physicians should use clinical judgment or consult.
Refer to local health department for environmental investigation and
Public Health Nurse Visit.
Provide counseling regarding appropriate nutrition and cleanlinessremoval of paint chips and dust.
Succimer is preferred unless compliance requires use of CaNa2EDTA
CaNa2EDTA for 5 days, preferably by continuous infusion, or in divided
doses (through a heparin lock).
Additional treatment may be needed depending on blood lead level
rebound.
A minimum of 2 weeks between courses is recommended unless more
treatment is indicated.
Refer to local health department for environmental investigation and
Public Health Nurse Visit.
Provide counseling regarding appropriate nutrition and cleanliness—
removal of paint chips and dust.
BAL 300 mg/m2/day and
Start with BAL 50 mg/m2 IM every 4 hours.
CaNa2EDTA 1000 mg/m2/day
After 4 hours, start CaNa2EDTA 1000 mg/m2/day, preferably by
continuous infusion, or in divided doses IV (through a heparin lock).
Continue therapy with CaNa2EDTA for 5 days.
BAL may be discontinued after 3 days if blood lead level <50 mcg/dL
Additional treatment may be needed depending on blood lead level
rebound.
SYMPTOMATIC CHILDREN
Acute encephalopathy
Pediatric evaluation
Screen for iron deficiency amenia
Monitor blood lead levels
Hospitalization.
Refer to local health department for environmental investigation and
public Health Nurse Visit.
BAL 450 mg/m2/day and
Start with BAL 75 mg/m2 IM every 4 hours.
CaNa2EDTA 1500 mg/m2/day
After 4 hours, start continuous infusion of CaNa2EDTA 1500 mg/m2/day.
Provide counseling regarding appropriate nutrition and cleanlinessremoval of paint chips and dust.
Continue therapy with BAL and CaNa2EDTA for 5 days. Interrupt therapy
for 2 days.
Treat for 5 additional days, including BAL if blood lead remains high.
Other symptoms
Pediatric evaluation
Screen for iron deficiency anemia
Monitor blood lead levels
Other cycles may be needed depending on blood lead level rebound.
Refer to local health department for environmental investigation and
public Health Nurse Visit.
Provide counseling regarding appropriate nutrition and cleanlinessremoval of paint chips and dust.
BAL 300 mg/m2/day
Start with BAL 50 mg/m2 IM every 4 hours.
CaNa2EDTA 1000 mg/m2/day
After 4 hours start CaNa2EDTA 1000 mg/m2/day, preferably by
continuous infusion, or in divided doses IV (though a heparin lock).
Continue therapy with CaNa2EDTA for 5 days.
Discontinue BAL after 3 days if blood lead level <50 mcg/dL. Interrupt
therapy for 2 days.
Treat for 5 additional days, including BAL if blood lead remains high.
Additional treatment may be needed depending on blood lead rebound.
Adapted from Illinois Department of Public Health