lead toxin

• cause: lead based paint, dust (old houses before 1978)
• sx: asymptomatic, pica, abd pain, cognitive impairment, encephalopathy if severe
• dx: finger stick testing confirmed by venous blood level
  • peripheral smear shows basophilic stippling
  • xray shows lead lines
• rx: chelate when level over 45
• prognosis: levels as low as 10-20 μg/dL are associated with cognitive impairment and behavioral problems (eg, attention-deficit hyperactivity disorder) that may not manifest until school initiation. Cognitive deficits can persist throughout childhood and beyond adolescence.

DMSA (succimer) is an oral medication used to treat children with moderate lead intoxication. It has a very low risk of toxicity.

Children with severe lead intoxication should be treated with parenteral dimercaprol and EDTA. Intravenous deferoxamine is the treatment of choice for serious iron overdoses.