Care of the Child with Lead Poisoning

Care of the Child with Lead Poisoning

Flint, Michigan

Lead Poisoning Man-made disease Became significant health issue in the 70 s

Sources of Lead Lead-based paint Lead soldering of cans ◦ Sealant Drinking water systems Eye cosmetics from other countries storage batteries kohl or kajol eyeliners Litargirio (lead monoxide) powder used as deodorant in Hispanics Bullets, curtain weights, and fishing sinkers made of lead Soil polluted by car exhaust or chipping house paint Ceramic glazes ◦ Mexican pottery Folk remedies ◦ Topical agents ◦ Alternative meds ◦ Chinese & Middle Eastern herbs for teething, colic, and GI d/o Toys and crayons made in China

Children at Risk Less than _____ years old Living in poverty House before 1978 Diet – low in -____, _____, and Vitamin _____

Symptoms of Lead Poisoning Signs of repeated lead exposure include: abdominal pain abdominal cramps aggressive behavior constipation sleep problems headaches irritability loss of developmental skills in children loss of appetite fatigue high blood pressure numbness or tingling in the extremities memory loss anemia kidney dysfunction Signs of lead poisoning on a developing brain: behavior problems low IQ poor grades at school problems with hearing short- and long-term learning difficulties growth delays Symptoms occur _______!

Diagnosis BLL > _______ mcg/dl X Rays

Management *1 st step of treatment is to _________ and _______ the source of the lead! 5 -14 mcg/dl Confirm & then repeat within 3 mos 15 -19 mcg/dl Repeat within 2 mos 15 -19 mcg/dl X 2 or >20 mcg/dl Nutrition, environmental change >45 mcg/dl Chelation therapy (Carbonyl (CO) & hydroxyl (OH)

Nutrition Foods high in _____, _____ and vitamin _____ protect the body against lead poisoning. Choose LOWFAT Foods Since Fat Helps the Body Take in Lead Limit foods with ________, such as potato chips, cakes, cookies, doughnuts, pies, and other snacks. Remember. . . always wash your child’s hands before eating, to wash off any lead dust.

Chelating Agents Succimer (DMSA, Chemet) ◦ preferred for low-level lead poisoning ◦ oral for 21 -26 days ◦ rebound elevation in lead level in 1 -2 wks ◦ rebound is usually 2/3 of original level ◦ if high enough; give another round of succimer ◦ nausea, vomiting, hives, nephropathy, elevated LFTs

Chelating agents cont. Calcium disodium (EDTA) ◦ used for levels over 75 mg/dl ◦ IV for 5 days ◦ more side effects than succimer: kidney damage, worsened brain injury, nausea, vomiting, chills, myalgia, hypocalcemia ◦ 8 -24 hr urine collection

Chelating Agents cont. BAL (dimercaprol) ◦ IM ◦ Levels over 100 mcg/d. L ◦ Used in ICU ◦ more side effects than succimer

Prioritize Your pt. has elevated lead levels, HA, vomiting & seizures What would be your 1 st, 2 nd, & 3 rd interventions? 1. ABC’s 2. Assess/monitor LOC & assess changes 3. Prevent further absorption

Prevention Clean Reduce risk Do not remove lead paint yourself Get lead out of your drinking water Nutrition