Materiały źródłowe

• #1

  https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=1203&toxid=22

  There is no antidote for lead. Lead poisoning is treated with chelation therapy. Protocols may vary depending on blood lead levels and whether patients are children or adults. […] The treatment course for lead poisoning is determined by confirmed results of lead levels in venous blood. Removal from exposure may be followed by chelation therapy in patients with blood lead levels between 45 and 70 g/dL. Chelation therapy is required in patients with clinical symptoms suggesting encephalopathy. […] Chelation therapy should be considered for treatment of severe symptoms or markedly elevated blood lead levels. Chelation therapy is controversial in cases of asymptomatic and mildly symptomatic intoxication and should never be given prophylactically or during ongoing lead exposure. Once initiated, chelation therapy should be continued until symptoms improve and acceptable blood lead levels are achieved.

• #2 Lead Toxicity Treatment & Management: Approach Considerations, Chelation Therapy, Dietary Measures

  https://emedicine.medscape.com/article/1174752-treatment

  The most important step in treatment is to prevent further exposure to lead. Accurate assessment of environmental and occupational exposure is essential. Modifying childrens behavior to decrease hand-to-mouth activity is beneficial. […] Medical treatment (ie, chelation therapy) is but one element of a comprehensive treatment plan for exposure to lead; removal of the source of lead exposure is more important. The interventions described below relate to chelation therapy for the most severe cases of lead poisoning. Chelation is of only transient benefit in the patient whose source of lead exposure has not been identified and removed. […] Chelation therapy, especially in the setting of encephalopathy, can be complicated. If appropriate facilities for treatment are not available, consider transfer to an institution that is capable of managing an encephalopathic patient and also has a provider experienced in lead poisoning and chelation therapy. Ideally, children should be treated in specialized pediatric intensive care units.

• #3 Lead poisoning – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lead-poisoning/diagnosis-treatment/drc-20354723

  The first step in treating lead poisoning is to remove the source of the contamination. If you can’t remove lead from your environment, you might be able to reduce the likelihood that it will cause problems. […] For more-severe cases, your doctor might recommend: […] Chelation therapy. In this treatment, a medication given by mouth binds with the lead so that it’s excreted in urine. Chelation therapy might be recommended for children with a blood level of 45 mcg/dL or greater and adults with high blood levels of lead or symptoms of lead poisoning. […] ethylenediaminetetraacetic acid (EDTA) chelation therapy. Health care providers treat adults with lead levels greater than 45 mcg/dL of blood and children who can’t tolerate the drug used in conventional chelation therapy most commonly with a chemical called calcium disodium ethylenediaminetetraacetic acid (EDTA). EDTA is given by injection.

• #4 Treatment of Lead Poisoning

  https://www.aap.org/en/patient-care/lead-exposure/treatment-of-lead-poisoning/?srsltid=AfmBOooM1k3TvUw3jk4nu6kO3NMRRaEthoS8j42sxLCnlx1grxtnUEUK

  Primary prevention is the optimal treatment. However, as children are not found to have lead in their environment until they have an elevated blood lead level, treatment for lead exposure should be provided to all children with a blood lead level of 3.5 micrograms per deciliter or greater. The primary management includes: finding and eliminating the source of the lead, instruction in personal and household hygiene measures, optimizing the child’s diet and nutritional status, and close follow-up. […] Any treatment regimen that does not control environmental exposure to lead is considered inadequate. […] The CDC Lead Poisoning and Prevention, Guidelines and Recommendations support effective childhood lead poisoning prevention programs. […] Chelation therapy for children with blood lead levels of 20 to 44 micrograms per deciliter can be expected to lower blood lead levels, but it has not been shown to reverse or diminish cognitive impairment or other behavioral or neuropsychological effects of lead. If the blood lead level is greater than 45 micrograms per deciliter and the exposure has been controlled, treatment should begin.

• #5 Lead Poisoning in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0315/p751.html

  If a child’s blood lead level is measured as greater than 20 g per dL (0.97 mol per L) once, or greater than 15 g per dL (0.72 mol per L) twice, environmental investigation, including a home inspection, should be conducted. […] For children with a blood lead level of less than 10 g per dL, providing basic nutritional and environmental education to parents may be of benefit, although the true effectiveness is unknown. […] The CDC currently recommends testing all children with elevated blood lead levels for iron deficiency and correcting the deficiency.

• #6 Lead Poisoning | HealthLink BC

  https://www.healthlinkbc.ca/healthwise/lead-poisoning

  Treatment for lead poisoning includes removing the source of lead, getting good nutrition, and, in some cases, having chelation therapy. […] Removing the source of lead. Old paint chips and dirt are the most common sources of lead in the home. Lead-based paint, and the dirt and dust that come along with it, should be removed by professionals. In the workplace, removal usually means removing lead dust that’s in the air and making sure that people don’t bring contaminated dust or dirt on their clothing into their homes or other places. […] Good nutrition. Eating foods that have enough iron and other vitamins and minerals may be enough to reduce lead levels in the body. A person who eats a balanced, nutritious diet may absorb less lead than someone with a poor diet. […] Chelation therapy. If removing the lead source and getting good nutrition don’t work, or if lead levels are very high, you may need to take chelating medicines. These medicines bind to lead in the body and help remove it. […] The best way to avoid lead poisoning is to prevent it. Treatment cannot reverse any damage that has already occurred. But there are many ways to reduce your exposure and your child’s before it causes symptoms.

• #7 Lead poisoning – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lead-poisoning/symptoms-causes/syc-20354717

  There is treatment for lead poisoning, but taking some simple precautions can help protect you and your family from lead exposure before harm is done. […] Simple measures can help protect you and your family from lead poisoning: […] Regular meals and good nutrition might help lower lead absorption. Children especially need enough calcium, vitamin C and iron in their diets to help keep lead from being absorbed. […] If your home has lead-based paint, check regularly for peeling paint and fix problems promptly. Try not to sand, which generates dust particles that contain lead.

• #8 Lead poisoning – Wikipedia

  https://en.wikipedia.org/wiki/Lead_poisoning

  The major treatments are removal of the source of lead and the use of medications that bind lead so it can be eliminated from the body, known as chelation therapy. […] Chelation therapy in children is recommended when blood levels are greater than 40-45 g/dL. […] The mainstays of treatment are removal from the source of lead and, for people who have significantly high blood lead levels or who have symptoms of poisoning, chelation therapy. […] Treatment of iron, calcium, and zinc deficiencies, which are associated with increased lead absorption, is another part of treatment for lead poisoning. […] The chelating agents used for treatment of lead poisoning are edetate disodium calcium (CaNa2EDTA), dimercaprol (BAL), which are injected, and succimer and d-penicillamine, which are administered orally.

• #9 Integration and implementation of the recommendations in the management of lead poisoning – WHO guideline for clinical management of exposure to lead – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK575290/

  The patient or carer should be given information about the harmful health effects of lead, about sources of exposure and how exposure can be reduced or avoided, including the importance of good nutrition, in particular adequate intake of iron and calcium and of vitamins C and D, as these facilitate absorption of iron and calcium, respectively. If necessary nutritional supplementation should be given. […] Issues in the choice of chelating agent for treatment are discussed in section 7.3.9. […] Patients with severe lead poisoning may have seizures, raised intracranial pressure, cerebral oedema and coma. Supportive management for these conditions should be provided in accordance with the usual hospital management protocols. […] Whether or not chelation therapy has been given, it is important to re-evaluate the patient periodically, including the blood lead concentration, to determine the effectiveness of measures to terminate exposure and chelation and whether further action is necessary.

• #10 Lead Poisoning (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/lead-poisoning.html

  The most important part of treatment is preventing more exposure to lead. The doctor will ask about the home to try to identify possible sources of lead. If a child has lead poisoning, all siblings should be tested. […] Calcium, iron, and vitamin C are important parts of a healthy diet and also help decrease how much lead the body absorbs. The doctor may recommend a multivitamin with iron for a child who doesnt get enough of these important nutrients in their diet. […] Kids with high lead levels and symptoms of lead poisoning may need care in a hospital to get a medicine called a chelator (KEE-lay-ter). The chelator helps remove the lead from the body. […] The effects of lead on development may not show up for years. Doctors will closely follow the development of children with lead exposure at all regular checkups.

• #11 Recommendations for specific treatment interventions – WHO guideline for clinical management of exposure to lead – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK575289/

  This section provides WHO recommendations on specific aspects of the clinical management of patients with lead poisoning and descriptions of the type and strength of the evidence for each. The recommendations are for: […] The single most important action in the management of any lead exposure is to take measures to stop the exposure as quickly as possible. This alone will itself result in a reduction in the blood lead concentration and clinical improvement. […] The aim of GI decontamination is to remove lead objects or lead compounds from the GI tract and reduce or prevent absorption, thereby reducing the risk and severity of lead poisoning. […] Evidence was sought for the impact of GI decontamination on the following outcomes: […] The search found only case reports and small case series describing GI decontamination following lead ingestion.

• #12 Recommendations for specific treatment interventions – WHO guideline for clinical management of exposure to lead – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK575289/

  The recommendations below suggest use of medical imaging in certain circumstances to confirm the presence of and locate and monitor the movement of lead in the GI tract. […] Take measures to remove solid lead objects, such as a bullets, lead pellets, jewellery, fishing or curtain weights, that are known to be in the stomach. […] Consider whole bowel irrigation for removing solid lead objects, such as a bullets, lead pellets, jewellery, fishing or curtain weights that are known to have passed through the stomach. […] Consider surgical removal of solid lead objects, such as bullets or lead pellets, that are known to be in the appendix if the patient shows clinical signs of appendicitis or an increasing blood lead concentration. […] Consider whole bowel irrigation for removing liquid or solid lead-containing substances, such as paint chips, lead-containing complementary or alternative medicines or ceramic glaze, when the material is known to be dispersed in the gut.

• #13 Recommended Actions Based on Blood Lead Level | Childhood Lead Poisoning Prevention | CDC

  https://www.cdc.gov/lead-prevention/hcp/clinical-guidance/index.html

  CDC recommends that healthcare providers use a venous draw for confirmatory BLL screening. […] The healthcare provider is consulting with a medical toxicologist or pediatrician with experience in treating lead poisoning to initiate: gastrointestinal decontamination (removal of swallowed lead using laxatives) or chelation therapy (a treatment that uses a medication to remove lead from the body when BLLs are very high). […] If the patient exhibits signs or symptoms of lead poisoning, including confusion, weakness, seizures, coma, nausea, vomiting, and abdominal pain, admit them to a hospital as soon as possible.

• #14 Lead poisoning: Symptoms, in children, in adults, causes

  https://www.medicalnewstoday.com/articles/306601

  As with most types of poisoning, the first step is to identify and remove the source of the poison. […] If removing the source does not reduce blood levels, the following may be necessary: […] Chelation therapy: This involves medication that binds with the lead and allows it to be passed in the urine or feces. […] Additionally, if there are concerns that someone has eaten a life-threatening amount of lead in one dose, the following procedures might be needed: […] Bowel irrigation: Flushing out the entire gastrointestinal tract with large volumes of polyethylene glycol solution […] Gastric lavage: Also called gastric suction or stomach pumping, this involves washing out the stomach via a tube and saline irrigation inserted into the throat. […] Intravenous fluid administration may be necessary.

• #15 Lead poisoning: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/002473.htm

  Chelation therapy (compounds that bind lead) is a procedure that can remove high levels of lead that have built up in a person’s body over time. […] In cases where someone has potentially eaten a high toxic dose of lead in a short period of time, the following treatments might be done: Bowel irrigation (flushing out) with polyethylene glycol solution, Gastric lavage (washing out the stomach).

• #16 Lead Poisoning: Causes, Symptoms, Testing & Prevention

  https://my.clevelandclinic.org/health/diseases/11312-lead-poisoning

  Lead poisoning can be diagnosed through a blood lead test. Treatment includes finding and removing the source of the lead to prevent further exposure. […] If your child’s blood lead levels are very high, your child’s healthcare provider may treat them with a medication called a chelating agent. This medicine binds the lead in your child’s blood and makes it easier for their body to get rid of it. […] Your child’s healthcare provider may also recommend whole-bowel irrigation. With this procedure, your child’s healthcare provider gives your child a special solution called polyethylene glycol by mouth or through a stomach tube to wash out the contents of your child’s stomach and intestines. Bowel irrigation is aimed at preventing further lead absorption if there are lead paint chips identified on an X-ray of your child’s belly. […] The effects of lead poisoning aren’t reversible. But you can reduce blood lead levels and prevent further exposure by finding and removing the sources of lead from your child’s home or environment.

• #17 Lead Toxicity and Chelation Therapy

  https://www.uspharmacist.com/article/lead-toxicity-and-chelation-therapy

  Chelation therapy works by binding to lead in the blood and soft tissues and creating a compound that can be excreted in the bile and urine. It should only be administered with oversight by a specialist. […] It has been found that chelation in children with a BLL 45 mcg/dL will decrease their BLL, but it will not improve neurodevelopmental test scores. Therefore, chelation therapy is usually reserved for patients with a BLL 45 mcg/dL. […] There are currently two parenteral (dimercaprol and CaNa2EDTA) and two oral (succimer and D-penicillamine) agents available. […] Dimercaprol is contraindicated in patients with a peanut allergy or hepatic insufficiency. […] CaNa2EDTA has been found to increase lead concentrations in the central nervous system and cause encephalopathy. […] It has been found that treatment with dimercaprol prior to CaNa2EDTA therapy may decrease the risk for encephalopathy due to the CaNa2EDTA.

• #18 Recommendations for specific treatment interventions – WHO guideline for clinical management of exposure to lead – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK575289/

  Good nutrition is important in protecting and mitigating against the toxic effects of lead. […] Chelating agents are antidotes for lead poisoning and included in WHO Essential List of Medicines. […] The aim of chelation therapy is to facilitate renal excretion, thereby decreasing the lead body burden and, potentially, resolving toxic effects and improving clinical outcomes by decreasing the availability of lead for binding at its sites of action. […] The recommendations for chelation therapy are differentiated according to threshold blood lead concentrations, age, sex, and severity of lead poisoning. […] For a child (10 years) with a blood lead concentration 45 g/dL, oral or parenteral chelation therapy is recommended. […] For a child (10 years) with lead encephalopathy, urgent hospital admission and parenteral chelation therapy are recommended.

• #19

  https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=1203&toxid=22

  Children with blood lead levels between 45 and 70 g/dL should undergo chelation, usually with oral succimer; those with encephalopathy or with blood lead levels in excess of 70 g/dL should be admitted to the hospital for parenteral therapy with BAL and EDTA. Therapy begins with BAL intramuscularly every 4 hours, establishment of adequate urinary output (hydration as needed), followed by CaNa2-EDTA continuous infusion. […] There is no antidote for lead. Seriously exposed persons may need to be hospitalized and undergo chelation therapy to accelerate the excretion of lead from the body. Chelation therapy is necessary when blood lead levels are higher than 45 g/dL.

• #20 Lead Toxicity Treatment & Management: Approach Considerations, Chelation Therapy, Dietary Measures

  https://emedicine.medscape.com/article/1174752-treatment

  With acute lead poisoning, the indications for chelation therapy are well defined. Institute chelation therapy in children with BLLs of 45 g/dL or higher. Treat children whose BLLs are 70 g/dL or higher as medical emergencies. […] In adults, consider chelation therapy for patients with blood lead levels BLLs of 70 g/dL or higher. Also consider chelation therapy in symptomatic adults with BLLs exceeding 50 g/dL. Available chelation agents for adults are dimercaprol and CaNa2 EDTA; penicillamine and succimer do not have US Food and Drug Administration (FDA) approval for this application, although they are effective treatments. […] Chelation therapy reverses Fanconi syndrome, transient hypertension, and tubular structural changes observed on histopathology findings. […] Patients with chronic lead nephropathy, in the absence of marked interstitial fibrosis and with only minimal impairment in kidney function, may respond to chelation therapy.

• #21 Occupational Lead Poisoning | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/0215/p719.html

  In all cases of suspected lead intoxication in adults, the first step in management should be removal of the individual from the exposure. […] Whether discontinuation of exposure is sufficient treatment or chelation therapy should be administered depends on the blood lead concentration, the severity of clinical symptoms, the biochemical and hematologic abnormalities, and the nature of the exposure. It is not recommended that specific blood lead concentrations be used to determine when treatment with a chelating agent is indicated. As a general rule, however, such a level is usually well above 80 g per dL (3.85 mol per L), which is also the level frequently associated with more severe symptoms. The primary indication for treatment of adults is brief, high-level exposure causing acute manifestations.

• #22 Lead toxicity – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/755

  Lead toxicity occurs after occupational or home exposure to lead. There is no threshold level for toxicity. […] The mainstay of treatment is removal of the source. Chelation therapy is given for blood levels 2.2 micromoles/L (45 micrograms/dL) in a child or 3.4 micromoles/L (70 micrograms/dL) in an adult, or if the patient is symptomatic. […] Acute lead encephalopathy is a medical emergency requiring aggressive chelation therapy in an intensive care setting. […] Lead resides in bone for decades after exposure has ceased; all patients require long-term monitoring.

• #23 Recommendations for specific treatment interventions – WHO guideline for clinical management of exposure to lead – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK575289/

  The guideline development group considered that the balance of harms and benefits favoured removal of a lead object to prevent potentially severe or fatal lead poisoning and advised a strong recommendation. […] The only evidence for use of chelation in pregnant women was from case reports, most of which concerned women in the third trimester of pregnancy. […] For a pregnant woman with lead encephalopathy, regardless of trimester, urgent chelation therapy is recommended. […] In the second and third trimesters, teratogenicity is no longer a concern. […] The intended outcomes of chelation therapy in a pregnant woman are survival of the mother and the fetus, in the case of lead encephalopathy, and more generally, improvement in clinical features of lead poisoning and reduction of lead exposure of the fetus.

• #24 Lead Poisoning – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/poisoning/lead-poisoning

  Treatment involves stopping lead exposure and sometimes using chelation therapy with succimer or edetate calcium disodium, with or without dimercaprol. […] Chelation for adults with symptoms of poisoning plus whole blood lead level (PbB) 70 mcg/dL (3.38 micromol/L). […] Chelation for children with encephalopathy or PbB 45 mcg/dL (2.17 micromol/L). […] For all patients, the source of lead should be eliminated. […] Chelating agents (eg, succimer [meso-2,3-dimercaptosuccinic acid], CaNa2EDTA [calcium disodium ethylenediaminetetraacetic acid] dimercaprol [British antilewisite, or BAL]) can be given to bind lead into forms that can be excreted. […] Chelation is indicated for adults with symptoms of poisoning plus PbB 70 mcg/dL (3.38 micromol/L) and for children with encephalopathy or PbB 45 mcg/dL (2.17 micromol/L).

• #25 Lead Poisoning in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0315/p751.html

  The CDC recommends that the threshold for follow-up and intervention of lead poisoning be a blood lead level of 10 g per dL or higher. Recommendations for treatment of elevated blood levels include a thorough environmental investigation, laboratory testing when appropriate, iron supplementation for iron-deficient children, and chelation therapy for blood lead levels of 45 g per dL or more. […] Chelation therapy is recommended only for blood lead levels of 45 g per dL (2.17 mol per L) or greater. […] Chelation therapy is usually done with succimer (Chemet), but dimercaprol (Bal in oil) can also be used. Succimer is preferred because it can be administered orally and is better tolerated. […] Children with levels higher than 70 g per dL (3.38 mol per L) should be hospitalized immediately for treatment under direct medical supervision.

• #26 Lead toxicity and chelation therapy – Creighton University

  https://researchworks.creighton.edu/esploro/outputs/magazineArticle/Lead-toxicity-and-chelation-therapy/991005930377202656

  Lead toxicity is a major public health concern because it can cause cognitive, behavioral, and motor problems in children. […] There are four available agents used to treat lead toxicity: dimercaprol, CaNa2EDTA, succimer, and D-penicillamine. […] Pharmacists can play an important role in education, treatment, and monitoring of children with lead toxicity. […] The key to reducing the public burden of lead poisoning is prevention and education.

• #27 Lead Poisoning – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/poisoning/lead-poisoning

  Patients with encephalopathy are treated with dimercaprol 75 mg/m2 (or 4 mg/kg) IM every 4 hours and CaNa2 EDTA [calcium disodium versenate] 1000 to 1500 mg/m2 IV (infusion) once/day. […] Patients without encephalopathy are usually treated with succimer 10 mg/kg orally every 8 hours for 5 days, followed by 10 mg/kg orally every 12 hours for 14 days. […] Use succimer as first-line chelation therapy in asymptomatic or minimally symptomatic patients with mildly elevated lead level. Alternatively, dimercaprol with or without CaNa2 EDTA may be used for symptomatic patients without encephalopathy. Encephalopathic patients are aggressively treated with combination dimercaprol/CaNa2 EDTA chelation.

• #28 Lead Poisoning: Causes, Symptoms, and Treatment

  https://patient.info/doctor/lead-poisoning-pro

  Lead poisoning treatment and management requires immediate treatment in hospital for acute poisoning, especially with encephalopathy. Chelation therapy is recommended if blood lead level is 45 g/dL or higher. For blood levels between 20 and 45 g/dL, treatment is indicated if the child is symptomatic. Asymptomatic children with blood levels below 20 g/dL require long-term neurodevelopmental follow-up, and counselling is required. In all cases, immediate removal of the source of lead exposure is essential. […] Severe lead poisoning (levels 60 g/dL) due to acute ingestion may require airway maintenance, management of coma and seizures, intravenous (IV) drip of normal saline, and orogastric or nasogastric catheter and irrigation. […] Parenteral chelators such as calcium disodium edetate given intramuscularly (IM) or IV are used. There is a growing trend to administer it by slow IV drip.

• #29 Lead Toxicity and Chelation Therapy

  https://www.uspharmacist.com/article/lead-toxicity-and-chelation-therapy

  Succimer is a derivative of dimercaprol that can be administered orally. […] D-penicillamine is usually used as a follow-up treatment to CaNa2EDTA or dimercaprol to stop the BLL from rebounding after parenteral treatment. […] Due to adverse events, D-penicillamine should be used as a third-line treatment for lead toxicity.

• #30 Lead poisoning – Wikipedia

  https://en.wikipedia.org/wiki/Lead_poisoning

  Chelation therapy is used in cases of acute lead poisoning, severe poisoning, and encephalopathy, and is considered for people with blood lead levels above 25 g/dL. […] While the use of chelation for people with symptoms of lead poisoning is widely supported, use in asymptomatic people with high blood lead levels is more controversial. […] Chelation therapy is of limited value for cases of chronic exposure to low levels of lead. […] Chelation therapy is usually stopped when symptoms resolve or when blood lead levels return to premorbid levels. […] When lead exposure has taken place over a long period, blood lead levels may rise after chelation is stopped because lead is leached into blood from stores in the bone; thus repeated treatments are often necessary.

• #31 Childhood lead poisoning: Management – UpToDate

  https://www.uptodate.com/contents/childhood-lead-poisoning-management

  The management of lead poisoning in children will be reviewed here. […] The only effective long-term treatment is ending further lead exposure by eradication of environmental lead contamination. […] Primary prevention of lead exposure is the single most important strategy in the management of childhood lead poisoning. […] Chelation therapy may be necessary depending upon the degree of blood lead elevation. […] However, it has limited efficacy. […] While chelating agents can bind to lead in blood, they are ineffective in removing lead from the deep bone stores.

• #32 Integration and implementation of the recommendations in the management of lead poisoning – WHO guideline for clinical management of exposure to lead – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK575290/

  Chelation therapy removes lead from blood and soft tissues, but, if there are significant bone stores, remobilization occurs, and the blood lead concentration will rise again. […] As children who have been exposed to lead may suffer impaired neurocognitive and behavioural development, the guideline development group advised periodic assessment for signs of difficulty in meeting developmental goals, ideally until the end of secondary education. These children should be given whatever support is available locally.

• #33 Lead Poisoning – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/poisoning/lead-poisoning

  Treatment consists of stopping exposure to lead and removing accumulated lead from the body. […] If an abdominal x-ray shows lead chips, a special solution of polyethylene glycol is given by mouth or through a stomach tube to flush out the contents of the stomach and intestines (a process called whole-bowel irrigation). […] Doctors remove lead from the body by giving medications that bind with the lead (chelation therapy), allowing it to pass into the urine. […] Succimer is one medication used in chelation therapy. […] People with mild lead poisoning are given succimer by mouth. […] People with more serious lead poisoning are treated in the hospital with injections of chelating medications, such as dimercaprol, succimer, and edetate calcium disodium. […] Because chelating medications also can remove beneficial minerals, such as zinc, copper, and iron, from the body, the person often is given supplements of these minerals. […] Even after treatment, many children with encephalopathy develop some degree of permanent brain damage.

• #34

  https://www.gov.uk/government/publications/lead-poisoning-advice-for-the-public-and-healthcare-professionals/lead-clinical-intervention

  Treatment options for lead poisoning in children include removal from exposure. Identification of the source of exposure may prove a challenge and requires a detailed history and often a degree of investigative imagination and persistence, acknowledging the principal sources of exposure outlined above. […] Management of cases where the blood lead concentration is 0.24 mol/L (5 g/dL) but below 2.4 mol/L (50 g/dL) normally involves only removal from exposure, however iron and calcium supplements may decrease both pica and absorption of lead. Chelation therapy may be considered in some cases of chronic poisoning. Expert advice should be sought in these cases. […] It is reasonable to offer chelation therapy to children who are symptomatic or have a BLC 2.4 mol/L (50 g/dL), although there is reliable evidence that chelation therapy does not improve cognitive function in children 3 years old with BLCs of 2.2 mol/L (45 g/dL). Chelation is futile however if re-exposure occurs following treatment.

• #35 Lead Poisoning: Chelation Therapy

  https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/lead-poisoning-chelation-therapy

  Chelation medicine draws lead out of the body through the kidneys and into the urine. It is important that your child drinks plenty of liquids to help get rid of the lead. […] Your child’s doctor will schedule blood lead level tests while your child has chelation therapy. They will be checked again several weeks after the treatment is finished.

• #36 How Lead Poisoning Is Treated

  https://www.verywellhealth.com/how-lead-poisoning-is-treated-4160802

  Intravenous chelation drugs are generally reserved for adults with a blood level greater than 45 mcg/dL and children who cannot tolerate oral chelating agents. […] Common side effects include fever, headache, nausea, fatigue, rash, vision changes, and blood in the urine. […] Chelation therapy is generally pursued in children with blood lead levels of 45 mcg/dL or greater. […] The decision to treat is an individual one based on a review of the potential benefits and risks. […] If lead levels in the blood are excessive, a procedure known as chelation therapy can help remove lead from the body. […] Symptoms of lead encephalopathy may be treated with anticonvulsants, steroids, and a diuretic drug called Osmitrol (mannitol). […] In cases of acute contamination (such as the accidental ingestion of lead), whole bowel irrigation, endoscopy, or surgery may be used.

• #37 June 23, 2023: With Dimercaprol no longer being manufactured, how should we treat severe lead poisoning? | Tennessee Poison Center | FREE 24/7 Poison Help Hotline 800.222.1222

  https://www.vumc.org/poison-control/toxicology-question-week/june-23-2023-dimercaprol-no-longer-being-manufactured-how-should-we-treat

  For patients with lead encephalopathy, succimer, in addition to intravenous CaNa2EDTA, may be considered but recommend calling the Poison Center immediately for advice. Non-antidotal methods to reduce an elevated ICP can also be considered, such as paralysis, sedation, and treatment with hyperosmolar agents along with CSF diversion. […] In some cases, toxicologists may recommend the use of expired dimercaprol with the capable patients acknowledgment of use. As such, the current supply should not be discarded and should be sequestered for potential further use.

• #38 Lead Poisoning – Center for Parent Information and Resources

  https://www.parentcenterhub.org/ohi-lead/

  Lead poisoning is diagnosed through a simple blood test. Results come back in a few days and show how much lead is in the bloodstream. A level of 10 micrograms per deciliter (mcg/dL) or greater is considered unsafe. All children 6 months through 6 years of age who are entering day care, preschool, or kindergarten should be screened for lead poisoning by a health care provider. […] If a child’s blood test shows that he or she has some lead in the blood, health care providers will typically provide the family with information on lead poisoning prevention, risk reduction, and nutritional counseling. […] If the level of lead in the child’s blood is high, a drug therapy called chelation may be necessary. Special drugs (called chelators) are given under a doctor’s directions or administered in the hospital. This medicine attaches to the lead and removes it from the body in the urine. […] When the level of lead in the blood is quite high, more than one treatment session may be required. Children with high levels of lead in their blood may be placed on special diets and need to be monitored closely to lower their risk of lead-related complications.

• #39 For Medicaid-Enrolled Children Diagnosed With Lead Toxicity in Five States, Documentation Reviewed for Diagnoses and Treatment Services Raises Concerns | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services

  https://oig.hhs.gov/reports/all/2022/for-medicaid-enrolled-children-diagnosed-with-lead-toxicity-in-five-states-documentation-reviewed-for-diagnoses-and-treatment-services-raises-concerns/

  When young children with confirmed blood lead levels do not receive timely followup testing and treatment services, they could be left vulnerable to continuing lead exposure and permanent developmental effects. […] Among the 166 children with sufficient medical record documentation to confirm their diagnoses, medical reviewers determined that half of the children did not receive comprehensive followup testing and treatment services (e.g., environmental assessments to determine the source of exposure) as recommended. […] We recommend that to address concerns related to the accuracy of claims data for Medicaid enrolled children diagnosed with lead toxicity, and related to the treatment component of EPSDT for these children, CMS (1) explore the discrepancy between Medicaid claims data and medical documentation for lead toxicity and implement solutions to ensure better oversight of the EPSDT program; and (2) issue guidance to reiterate State obligations under the EPSDT benefit to ensure access to services to correct or ameliorate confirmed blood lead levels identified during screenings.

• #40 TREATMENT OF LEAD POISONING IN PREGNANCY – UKTIS

  https://uktis.org/monographs/treatment-of-lead-poisoning-in-pregnancy/

  A corresponding patient information leaflet on TREATMENT OF LEAD POISONING IN PREGNANCY is available. […] Current National Poisons Information Service (NPIS) advice is that all adults with a blood lead concentration of ≥50 micrograms/dL (2.4 micromol/L) should be considered for chelation therapy. This includes women who are pregnant. […] The NPIS currently advises chelation with either intravenous sodium calcium edetate 75mg/kg/day or oral DMSA (succimer) 30mg/kg/day in non-pregnant individuals with a blood lead concentration of ≥50 micrograms/dL (2.4 micromol/L). […] UKTIS should be contacted directly to discuss the treatment of any pregnant patient, including those with blood lead concentrations of <50 micrograms/dL (2.4 micromol/L). [...] Exposure to lead chelating treatments at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy. Monitoring of fetal growth may be advisable following maternal exposure to lead.

• #41 Diagnosing Pediatric Lead Toxicity | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosing-pediatric-lead-toxicity/2005-12

  The first goal of lead poisoning treatment is to identify and then avoid or remove (when possible) the source of lead exposure. […] Caregiver education about the sources of lead and the neurodevelopmental hazards of lead exposure is critical to prevention. […] Unfortunately, the relative efficacies of most environmental lead removal techniques are less than ideal. […] Specialized cleaning methods like high-efficiency particulate air (HEPA) vacuuming and interior dust abatement must be done frequently in order to be effective at reducing lead levels. […] Residential paint hazard remediation is efficacious when pre-abatement blood levels are greater than 35 g/dL. […] According to this monograph, chelation therapy should commence at blood lead levels 45 g/dL. […] Oral succimer may be used, or, if the patient is hospitalized, calcium dissodium edentate (calcium EDTA) can be delivered intravenously. […] At extremely high blood lead levels (70 g/dL) or in children with symptoms of serious lead poisoning, the appropriate treatment is parenteral therapy with EDTA and hospitalization. […] Another agent, dimercaprol (or BAL) forms a nonpolar compound with lead that is excreted in bile and urine.

• #42

  https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health

  In 2021, WHO published Guidelines on clinical management exposure to lead. The guidelines recommend that for individuals with blood lead concentration equal to or greater than 5 g/dL, the source of lead exposure should be identified, and appropriate action taken to terminate exposure. […] WHO is preparing guidelines on prevention of lead exposure, which will provide policy-makers, public health authorities and health professionals with evidence-based guidance on the measures to protect the health of children and adults from lead exposure.

• #43 Integration and implementation of the recommendations in the management of lead poisoning – WHO guideline for clinical management of exposure to lead – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK575290/

  Sections 6 and 7 provide recommendations for specific aspects of the management of lead exposure. These should be integrated into an overall management plan for cases of lead poisoning. As a general principle, decisions about the management of lead poisoning should be made on the basis of the clinical condition of the patient, the circumstances of exposure, the blood lead concentration and trends in concentration and the best interests of the patient according to the resources available for treatment. […] Once lead exposure has been confirmed by measurement of an elevated blood lead concentration (section 6.2), the steps in the management of exposure are: taking a history to identify the source(s) of exposure; evaluating the severity of exposure in clinical examination and investigations; reducing and terminating exposure, including improving nutrition; GI decontamination if indicated; chelation therapy if indicated; other supportive measures if required; and follow-up to determine whether further management measures are necessary.

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