Millions of children continue to be at risk for lead exposure despite a dramatic decline over the past 4 decades, and hundreds present annually to emergency departments with lead poisoning. These patients can be challenging to identify due to their nonspecific presentation and frequent lack of known exposure. This issue will prepare the emergency clinician to identify and care for the lead-poisoned patient, focusing on: (1) identifying key historical features, signs, and symptoms at presentation; (2) the medical management of lead poisoning; and (3) formulation of a safe discharge plan.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Hauptman M, Bruccoleri R, Woolf AD. An update on childhood lead poisoning. Clin Pediatr Emerg Med. 2017;18(3):181-192. (Review article) DOI: 10.1016/j.cpem.2017.07.010
3. U.S. Centers for Disease Control and Prevention. CDC response to Advisory Committee on Childhood Lead Poisoning Prevention recommendations in "low level lead exposure harms children: a renewed call of primary prevention." Accessed March 5, 2022. (Guideline)
6. President’s Task Force on Environmental Health Risks and Safety Risks to Children. Key federal programs to reduce childhood lead exposures and eliminate associated health impacts. Accessed March 5, 2022. (Guideline)
7. President's Task Force on Environmental Health Risks and Safety Risks to Children. Federal action plan to reduce childhood lead exposures and associated health impacts. Accessed March 5, 2022 (Guideline)
11. * Dapul H, Laraque D. Lead poisoning in children. Adv Pediatr. 2014;61(1):313-333. (Review article) DOI: 10.1016/j.yapd.2014.04.004
12. U.S. Centers for Disease Control and Prevention. Childhood lead poisoning prevention. Blood lead reference value. Accessed March 5, 2022. (CDC website)
14. * Chandran L, Cataldo R. Lead poisoning: basics and new developments. Pediatr Rev. 2010;31(10):399-405. (Review article) DOI: 10.1542/pir.31-10-399
22. Tarragó O, Demers R. Agency for Toxic Substances and Disease Registry Case Studies in Environmental Medicine (CSEM) Lead Toxicity. Accessed March 5, 2022. (Review article)
23. American Academy of Pediatrics. Detection of lead poisoning. Accessed March 5, 2022. (AAP website)
38. * VanArsdale JL, Leiker RD, Kohn M, et al. Lead poisoning from a toy necklace. Pediatrics. 2004;114(4):1096-1099. (Case report) DOI: 10.3109/15563650.2013.792114
39. * Clifton JC 2nd, Sigg T, Burda AM, et al. Acute pediatric lead poisoning: combined whole bowel irrigation, succimer therapy, and endoscopic removal of ingested lead pellets. Pediatr Emerg Care. 2002;18(3):200-202. (Case report) DOI: 10.1097/00006565-200206000-00013
52. Agency of Toxic Substances and Disease Registry. How should patients exposed to lead be treated and managed? Accessed March 5, 2022. (Guideline)
53. * 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. 2001;344(19):1421-1426. (Multicenter randomized double blind placebo controlled trial; 780 patients) DOI: 10.1056/NEJM200105103441902
55. BAL in oil ampules. Accessed March 5, 2022. (Data sheet)
57. Calcium disodium versenate. Accessed March 5, 2022. (Data sheet)
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Keywords: lead, lead poisoning, lead exposure, blood lead level, BLL, lead encephalopathy, lead lines, chelating agents, chelating drugs, chelating medications, chelation therapy, chelation treatment, succimer, dimercaptosuccinic acid, DMSA, calcium disodium edetate, CaNa2EDTA, D-penacillamine, dimercaprol, British Anti-Lewisite, BAL
Ariella Nadler, MD
Sing-Yi Feng, MD, FAAP; Michael Levine, MD
April 2, 2022
May 1, 2025
Date of Original Release: April 1, 2022. Date of most recent review: March 5, 2022. Termination date: April 1, 2025.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits, subject to your state and institutional requirements.
ACEP Accreditation: Pediatric Emergency Medicine Practice is approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.
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AOA Accreditation: Pediatric Emergency Medicine Practice is eligible for up to 48 American Osteopathic Association Category 2-A or 2-B credit hours per year.
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Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.
Goals: Upon completion of this activity, you should be able to: (1) identify areas in practice that require modification to be consistent with current evidence in order to improve competence and performance; (2) develop strategies to accurately diagnose and treat both common and critical ED presentations; and (3) demonstrate informed medical decision-making based on the strongest clinical evidence.
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