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.
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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.