Running head: LEAD POISONING 1

NURS 640 Primary Heal h !are "# !hildren in he $amily Lead P"i%"ning in Pedia ri&% P"'ula i"n Linda Ngameduru Su(mi ed ": Dr) *arren+D"r%ey Dr) Raley !"''in S a e Uni,er%i y 1-.-.-01/

Introduction

LEAD POISONING

A# er he 'a%%age "# he P"i%"n Pre,en i"n Pa&0aging A& "# 11203 he 're,alen&e "# '"i%"ning% in &hildren ha% redu&ed drama i&ally) 4hi% la5 'r",ide% ha &er ain '" en ially danger"u% drug% and h"u%eh"ld 'r"du& % mu% (e %"ld in &hild+re%i% an &"n ainer%) H"5e,er3 in %'i e "# he%e im'r",emen %3 '"i%"ning remain% a %u(% an ial heal h &"n&ern3 5i h m"% &a%e% "&&urring in &hildren under 6 year% "# age 6Hea,ey3 -0078) !hildren are '"i%"ned hr"ugh a ,arie y "# %u(% an&e%3 al h"ugh n" all &"mm"n h"u%eh"ld i em% are li0ely " 'r"du&e %eri"u% 'r"(lem%) 9any '"i%"ning% %u&h a%3 n"n+'harma&eu i&al% 6&leaning 'r"du& %3 in%e& i&ide%8 and 'harma&eu i&al% 6A&e amin"'hen3 &"ugh and &"ld 're'ara i"n%8 re#le& he ready a&&e%%i(ili y "# he 'r"du& in he h"me3 5here 10: "# '"i%"ning% "&&ur 6Hea,ey3 -0078) Am"ng he many '"i%"ning%3 hi% 'a'er 5ill #"&u% "n lead '"i%"ning) 4he aim "# hi% 'a'er i% " de#ine and di%&u% lead
'"i%"ning3 i % e'idemi"l"gy3 he 'a h"'hy%i"l"gy3 diagn"%i%3 &lini&al mani#e% a i"n3 li era ure re,ie5%3 managemen 3 and he r"le "# he nur%e 'ra& i i"ner)

The Definition of Lead Poisoning Lead '"i%"ning i% a 'red"minan 3 %u(% an ial3 and a,"ida(le 'edia ri& 'r"(lem) Al h"ugh %ym' "ma i& lead '"i%"ning3 5i h i % rela ed le hal &"m'li&a ed en&e'hal"'a hy3 i% hardly %een "day3 many y"ung &hildren 5i h n" %ym' "m% ha,e Lead+le,el% ha are ele,a ed en"ugh " &au%e neur"l"gi& and in elle& ual damage 6Ge"rge3 Heen&y ; *""l#3 -0108) A% he harm#ul e##e& % "# l"5 le,el% "# Lead "n he de,el"'ing &en ral ner,"u% %y% em ha,e (een iden i#ied3 (l""d lead le,el% indi&a ing "<i&i y ha,e de&rea%ed) $"r in% an&e3 in 1111 he l"5er le,el "# (l""d lead &"n&en ra i"n 5a% %e a =10 mi&r"gram.dl3 a redu& i"n #r"m he 117> le,el "# =-> mi&r"gram.dl? h"5e,er3 he Ad,i%"ry !"mmi ee "n !hildh""d Lead P"i%"ning Pre,en i"n 6!!LPP8 re&en ly %ugge% ed " u%e a re#eren&e ,alue re're%en ing (l""d Lead le,el% in he 12)> h 'er&en ile 65hi&h i% > mi&r"gram%.dl8 6!en er #"r Di%ea%e !"n r"l and Pre,en i"n @!D!A3 -01-8)

LEAD POISONING

Al h"ugh he grea er ri%0 i% " '""r &hildren under 6 year% "# age li,ing in ur(an area%3 lead '"i%"ning a##e& % &hildren "# all %"&ial % ra a) $"r e<am'le3 &hildren "# 5eal hier #amilie% li,ing near lead %mel er% "r in an&ien h"me% in ren",a ed &i y area% are a ri%0 64ayl"r3 S&hniering3 Lan'hear ; B"ne%3 -0018) 4he de+leading 6a(a emen 8 'r"&e%% 6%anding3 %&ra'ing3 and (urning "# 'ain ed %ur#a&e%8 &"n ri(u e% %igni#i&an am"un % "# inge% ed and inhaled lead " inha(i an %) C"ung &hildren are 'redi%'"%ing " '"i%"ning hr"ugh inge% i"n due " heir de,el"'men &hara& eri% i&%) In#an % and "ddler% l",e u%ing "ral e<'erimen a i"n " e<'l"re heir en,ir"nmen 3 heir %en%e "# a% e i% le%% di%&rimina "ry? here#"re3 many un'ala a(le %u(% an&e% are inge% ed 64" " e al)3 -01-8) In addi i"n3 he de,el"'men al % age "# au "n"my and ini ia i,e #"r "ddler% and 're%&h""ler% in&rea%e heir inDui%i i,ene%% and re(elli"u% (eha,i"r) 4hi% age gr"u' la&0 "# a5arene%% "# danger and Imi a i"n i% al%" a '"5er#ul m" i,a "r) Epidemiology of Lead Poisoning 4he g",ernmen la5% and " her 'u(li& heal h '"li&ie% ha,e %igni#i&an ly 'layed a r"le in he redu& i"n "# a,erage le,el% in &hildren) H"5e,er3 he ra e% "# lead le,el i% % ill d"u(le a% high a% #"r Hi%'ani& and A#ri&an Ameri&an &hildren 5hen eDua ed 5i h *hi e &hildren? 5i h 7/: "# &hildren 5i h he highe% lead le,el% li,ing in '",er y 6Hea,ey3 -0078) In 11203 77: "# &hildren (el"5 age 6 had (l""d lead &"n&en ra i"n le,el% a(",e 10 mi&r"gram%.dl3 >: "# &hildren in 1110%3 and m"re de&line "# 1)6: (y -00- 6!D!3 -01-8) A&&"rding " !D! 6-01-83 here are a("u #"ur milli"n h"u%eh"ld% 5h" ha,e &hildren li,ing in hem ha are (eing e<'"%ed " a high le,el "# lead3 and he e% ima i"n "# hal# a milli"n U)S) &hildren age (el"5 > 5i h (l""d lead le,el% a(",e mi&r"gram%.dl) In he 'a% 3 he U)S3 !"n%umer Pr"du& Sa#e y !"mmi%%i"n re&alled lead+&"n amina ed &hildrenE% "y in&luding (rand% %u&h a% Fa man3 D"ra he E<'l"rer3 and

LEAD POISONING

4h"ma% and $riend% *""den Rail5ay #r"m he mar0e due " high lead &"n en 3 m"% ly in he 'ain ) 4here#"re3 i i% im'"r an " di%&ard any re&alled "y%) Factors Related to Lead Absorption Environmental factors) 4he m"% im'"r an &"n ri(u ing #a& "r " lead '"i%"ning i% he a,aila(ili y "# lead in he en,ir"nmen ) Lead en er% he %y% em ei her (y inge% i"n "r inhala i"n) In an un("rn #e u% lead &an en er he ("dy ran%+'la&en al i# he m" her i% e<'"%ed) 4he maG"r en,ir"nmen al %"ur&e% "# lead are de eri"ra ing lead+(a%ed 'ain 3 5hi&h &"n amina e% h"u%eh"ld du% and %"il? drin0ing 5a er &"n amina ed (y e<'"%ed lead %"lder "r "ld lead 'i'e%? "&&u'a i"n% and h"((ie% 5here 'aren % "r " her% in he h"u%e (ring h"me lead "n &l" he%3 %h"e%3 and %0in? and #"r %"me &hildren3 #"l0 remedie% "r &"%me i&%? a% 5ell a% he u%e "# lead+&"n aining '" ery "r leaded di%he% #"r #""d % "rage 6A(el%"hn ; San("rn3 -0108) Lead+(a%ed 'ain #r"m "ld h"u%ing remain% he m"% #reDuen %"ur&e "# lead '"i%"ning in &hildren) 9"% lead '"i%"ning re%ul % #r"m inge% i"n "# lead du% during n"rmal hand+ "+m"u h a& i,i y) A num(er "# &hildren ha,e (een 0n"5n " a& ually ea l""%e lead 'ain &hi'%) S"me &hildren are '"i%"ned during ren",a i"n "# heir h"me) A% men i"ned earlier3 %anding3 %&ra'ing3 and (urning &an relea%e large am"un % "# lead in " he air) In 1127 he U)S) !"n%umer Pr"du& Sa#e y !"mmi%%i"n #"r(id he %u''lemen ing "# Lead " 'ain % #"r re%iden ial u%e3 (u %u(% an ial %um% "# lead % ay% "n he 'ain ed in eri"r and e< eri"r %ur#a&e% "# "lder h"me% 64ayl"r3 S&hniering3 Lan'hear ; B"ne%3 -001? Hea,ey3 -0078) Al h"ugh he &hildE% h"me en,ir"nmen i% u%ually he %"ur&e "# lead3 " her (uilding%3 %u&h a% 're%&h""l% "r day&are &en er%3 a% 5ell a% a #riend "r rela i,eE% h"me3 &an &"n ri(u e " lead e<'"%ure)

LEAD POISONING

>

O her %igni#i&an %"ur&e% "# lead in he &hildE% en,ir"nmen are du% 3 %"il3 and air ha (e&"me &"n amina ed (y emi%%i"n% #r"m lead %mel er%) $"r una ely3 he u%e "# de+leaded ga%"line ha% %igni#i&an ly redu&e% he le,el "# lead in he air and he in&iden&e "# %e,ere lead '"i%"ning in &hildren 64ayl"r3 S&hniering3 Lan'hear ; B"ne%3 -001? Hea,ey3 -0078) Lead %"ldered &an% 5i h #""d 'r"du& %3 5hi&h ha,e (een "u la5ed in he Uni ed S a e%3 may % ill (e #"und 5i h im'"r ed 'r"du& %) Leaded &"n ainer%3 %u&h a% %"me 5a er #"un ain% and liDuid% % "red in lead &ry% al3 &an al%" &"n ri(u e " inge% ed %"ur&e% "# hea,y me al) U%ing "# lead+ &"n amina ed 5a er in 're'ara i"n "# a (a(y #"rmula i% "ne "# he maG"r %"ur&e% "# '"i%"ning in in#an % 6Hea,ey3 -0078) Child factors) De,el"'men ally3 y"ung &hildren are a ri%0 #"r lead '"i%"ning (e&au%e "# heir high le,el "# "ral a& i,i y) Par i&ularly during la e in#an&y and "ddlerh""d3 &hildren e<'l"re heir en,ir"nmen (y 'u ing an "(Ge& in heir m"u h) 4hi% n"rmal hand+ "+m"u h a& i,i y &"n ri(u e% " he am"un "# lead &hildren inge% in du% and dir ) Fe&au%e "# heir %iHe3 y"ung &hildren inhale air ha i% &l"%er " he gr"und3 5hi&h i% m"re hea,ily &"n amina ed 5i h lead) In addi i"n3 he &hild 5h" inge% % lead "# en 'ra& i&e% 'i&a3 he ha(i ual3 'ur'"%e#ul3 and &"m'ul%i,e inge% i"n "# n"n+#""d %u(% an&e% 6A(el%"hn ; San("rn3 -0108) !hildren under he age "# 6 are al%" m"% a ri%0 #"r lead '"i%"ning (e&au%e "# heir de,el"'ing ner,"u% %y% em%) In addi i"n3 hree " #i,e ime% m"re lead i% a(%"r(ed in &hildren han in adul %) A&&"rding " A(el%"hn ; San("rn 6-01083 &hildren a(%"r( lead ,ery 5ell #r"m he ga% r"in e% inal ra& a("u 40: ,er%u% >: " 1>: #"r adul % 6') >/18) Die % de#i&ien in ir"n and &al&ium? a% 5ell a%3 die % high in #a % 6 h"%e &"n aining many #ried #""d%83 al%" in&rea%e he e<'"%ure ri%0 #"r &hildren li,ing in leaded en,ir"nmen % 6A(%el%"hn ; San("rn3 -0108) 4he%e &"ndi i"n% ma0e i '"%%i(le

LEAD POISONING

#"r lead " (e m"re Dui&0ly and readily a(%"r(ed) 4he grea e% ri%0 a''ear% " (e #r"m ir"n de#i&ien&y3 e,en in he a(%en&e "# anemia) Analysis of Lead Poisoning Pathophysiology and Clinical anifestations

Generally3 inge% ed lead i% gradually e<&re ed hr"ugh he alimen ary ra& 3 0idney3 and " a le%%er degree3 %5ea ) 4he ("ne and ee h are he main % "rage h"u%e a("u 1>: "# he ("dy (urden "# lead 5here i i% iner 64" " e al)3 -01-8) H"5e,er3 5i h 'r"l"nged &"n%um' i"n he ra e "# a(%"r' i"n %ur'a%%e% he ra e "# elimina i"n3 and e<&e%% lead i% de'"%i ed in he i%%ue% and &ir&ula ing (l""d a a&hed " he ery hr"&y e%) E,en 5hen he &"n inuing &"n%um' i"n % "'%3 i a0e% he ("dy 5i&e a% l"ng " elimina e he de'"%i ed lead a% i did " a&&umula e i ) A% a re%ul 3 numer"u% ("dy %y% em% &"n inue " (e a##e& ed a# er he en,ir"nmen al rem",al "# he '"i%"n 64" " e al)3 -01-8) The Central !ervous "ystem) 4he grea e% im'li&a i"n and 'ermanen %ide e##e& % "# lead in "<i&a i"n are "n he ner,"u% %y% em) Primarily3 Imem(rane 'ermea(ili y in&rea%e%3 5i h a %hi# "# #luid in " he in er% i ial %'a&e% "# he (rainJ and he &"n%eDuen&e i% an Iin&rea%ed in ra&ranial 're%%ure &au%e% &"r i&al a r"'hy and lead en&e'hal"'a hyJ 6&"n,ul%i"n%3 men al re arda i"n3 (lindne%%3 'araly%i%3 &"ma3 and dea h83 5hi&h i% alm"% al5ay% lin0ed 5i h a (l""d lead le,el "# K100 mi&r"gram.dl 64" " e al)3 -01-8) N"ne hele%%3 (e#"re lead en&e'hal"'a hy ha''en%3 l"5+d"%e e<'"%ure " lead &au%e% neur"l"gi& and in elle& ual de#i&i % ha may "r may n" (e re,er%i(le) Hy'era& i,i y3 aggre%%i"n3 im'ul%i,ene%%3 de&rea%ed in ere% in 'lay3 le hargy3 irri a(ili y? hearing im'airmen 3 %h"r a en i"n %'an3 learning 'r"(lem%3 and di% ra& i(ili y are "&&a%i"nally %een in l"5 le,el% "# lead '"i%"ning 6Ge"rge3 Heeney ; *""l#3 -0108) S udie%

LEAD POISONING

dem"n% ra e ha a% I'rena al and '"% na al lead le,el% ri%e%3 he &hildE% in elligen&e Du" ien #all%J 6A(el%"hn ; San("rn3 -0108) 9"% &hildren 5i h lead '"i%"ning d" n" %h"5 any %ign% and %ym' "m%3 ma0ing i harder " iden i#y early) The #ematological system) Lead i% e< remely I "<i& " he (i"%yn he%i% "# heme3 're,en ing he #"rma i"n "# hem"gl"(inJ and &au%ing i % 're&ur%"r%3 e%'e&ially ery hr"&y e 'r" "+'"r'hyrin 6EP83 !"'r"'"r'hyrin and del a+amin"le,ulini& a&id 6ALA83 " in&rea%e in he ("dy 64" " e al)3 -01-8) EP i% ele,a ed in he (l""d 5hen he (l""d lead &"n&en ra i"n i% m"dera ely in&rea%ed3 (u i% n" a %en%i i,e indi& "r #"r l"5 lead e<'"%ure) 4he redu& i"n "# he heme m"le&ule in he red (l""d &ell re%ul % in anemia) H"5e,er3 5i h l"5 le,el% "# lead "<i&i y3 anemia may n" (e 're%en ) Renal "ystem) 4he a(n"rmal e<&re i"n "# 'r" ein3 glu&"%e3 amin" a&id%3 and 'h"%'ha e are a re%ul "# Lead de% ru& i"n "# he &ell% "# he 'r"<imal u(ule% and in in er#eren&e 5i h he %yn he%i% "# ,i amin D 6Ge"rge3 Heeney3 ; *""l#3 -0108) *i h adeDua e rea men 3 0idney damage i% u%ually re,er%i(le) Se,ere3 irre,er%i(le lead ne'hr"'a hy i% 'r"(a(ly limi ed " 'r" ra& ed &hildh""d 'lum(i%m 64" " e al)3 -01-8) $ther "igns) O her un&lear %ym' "m% "# 'lum(i%m are a&u e3 an"re<ia3 &ram'ing a(d"minal 'ain3 &"n% i'a i"n3 ,"mi ing3 heada&he3 le hargy3 and l"%% "# de,el"'men al gr"5 h) A(el%"hn ; San("rn 6-0108 'r"'"%e% ha in y"ung &hildren Lead im'ede% gr"5 h3 'ar i&ularly in in#an % 5i h high 'rena al and '"% na al (l""d lead le,el) H"5e,er3 " her re%ear&her% ha,e #"und n" e##e& "n % a ure in y"ung adul % 5h" had (" h l"5 and high le,el% "# lead '"i%"ning during &hildh""d 6&i a i"n8) Literature Revie%

LEAD POISONING

*illiam%3 Lander%li&e3 ; $eliH 6-01-8 &"ndu& ed a % udy analyHing (l""d lead %&reening "# ->2 re#uge &hildren in Rh"de I%land #r"m year -007 " -011 addre%%ing he &"n&ern% "# 'la&ing a re#ugee in h"u%ing &"m'"nen % 5i h lead haHard% ha are adding " heir e<'"%ure) 4he re%ul %h"5ed ha he re#uge &hildren ha,e a (l""d lead le,el ranged #r"m Her" " -7 ug.dl3 -/ &hildren had 10 ug.dl "r grea er3 and > &hildren had 1> ug.dl "r grea er? and "# -/ &hildren 5h"%e FLL 5ere a(",e 10 ug.dl3 1-: 5ere under he age %i< and #"ur "# hem e<'erien&ed an in&rea%e in FLL a# er he 6h"u%ing 'la&emen 8 ini ial %&reening 6*illiam%3 Lander%li&e ; $eliH3 -01-8) A&&"rding " *illiam%3 Lander%li&e ; $eliH 6-01-83 I100 "# ->2 %&reened #r"m -007 " -011 #all in " he > " 1 ug.dl "# &"n&ernJ 6') 1-18) A% a re%ul "# hi% re%ear&h3 he !D! Ad,i%"ry !"mmi ee "n !hildh""d Lead P"i%"ning Pre,en i"n re&"mmended " &hange he lead le,el "# &"n&ern #r"m10 ug.dl "> ug.dl) Diagnosis of Lead Poisoning&Differential Diagnoses Ge"rge3 Heeney ; *""l# 6-0108 're%en ed a &a%e % udy "# a 4+year%+"ld au i% i& ("y 5h" had en&e'hal"'a hy 're%en ing 5i h a #lu+li0e %yndr"me) 4he ("y 5a% %een in an "u 'a ien &lini& #"r &"m'lain "# ga% r"in e% inal %ym' "m% 6,"mi ing ; a(d"minal &"li&8 and (eha,i"ral &hange%) He 5a% diagn"%ed and rea men #"r ,iral %yndr"me) 4he &hild re urn 5" day% la er 5i h %e,ere GI %ym' "m% and &hange in he le,el "# &"n%&i"u%ne%%3 and a(d"minal #ilm re,ealed 'ain &hi'% and (l""d lead le,el -16 ug.dl 6Ge"rge3 Heeney ; *""l#3 -0108) 4hi% &a%e % udy dem"n% ra e% he im'"r an&e "# 'r"m' re&"gni i"n and rea men "# lead '"i%"ning) 4" e e al) 6-01-8 Pre%en ed a &a%e % udy "# a >+year%+"ld girl diagn"%ed 5i h lead '"i%"ning mimi&0ing Guillain+Farre Syndr"me) 4hi% &hild 5a% %een #"r %e,ere u''er and l"5er e< remi ie% 5ea0ne%%3 mu%&le hy'" "nia3 and hy'" r"'hy 5i h"u any #amily hi% "ry "#

LEAD POISONING

neur"l"gi&al "r '%y&hia ri& di%"rder%) A&&"rding " 4" " e al) 6-01-83 he &hild did n" ha,e any 0n"5n ri%0 #a& "r% %u&h a%3 %"&i"e&"n"mi& &hara& eri% i&% "r '%y&h"'a h"l"gi&al (eha,i"ral #a& "r% " a 'redi%'"%i i"n " lead '"i%"ning) A%%e%%men #inding% re,eal %ign% "# anemia 5i h 'er%i% en n"rm"&y i& anemia3 lead le,el />- ug.dl3 en&e'hal"'a hy3 and 'eri'heral neur"'a hy 5i h al(umin &y "l"gi&al di%%"&ia i"n in &ere(r"%'inal #luid mimi&0ed Guillain+Farre Syndr"me 64" " e al)3 -01-8) 4he e%"'hagu%+ga% r"%&"'i& e<amina i"n %h"5ed a %mall me alli& ring #"und in he ga% ri& 5all3 indi&a ing ha he >+year+"ld had %5all"5ed he me alli& ring 5i h"u 'aren %E a5arene%%) 4he &"ur%e "# rea men #"r he &hild % ar ed 5i h %urgi&ally rem",al "# he me alli& ring and !hela i"n hera'y u%ing !al&ium di%"dium ede a e 6!aNa-ED4A8 1000 M 1>00 mg.m-.-4 h"ur% e,ery 6 h"ur% #"r > day% 64" " e al)3 -01-8) 4he &hildE% / m"n h% &he&0+u' %h"5ed im'r",emen in mu%&le % reng h%3 a gradual redu& i"n "# (l""d lead le,el? h"5e,er3 generaliHed end"n hy'"re#le<ia and hy'" "nia remain un&hanged) 4he &a%e 're%en a i"n% indi&a e ha he diagn"%i% "# lead '"i%"ning % ar % 5i h &are#ul neur"l"gi&al a%%e%%men and heal h hi% "ry) Diagn"%i% i% made "n mea%uremen "# (l""d lead le,el%) Sin&e ,ir ually all &hildren are a ri%0 #"r lead '"i%"ning3 uni,er%al %&reening i% re&"mmended) Pri"ri y #"r %&reening i% gi,en " &hildren age% 6 " 2- m"n h% 5h" are a highe% ri%0: h"%e 5h" li,e in "r #reDuen de eri"ra ed h"u%ing "r &er ain ge"gra'hi&al area% "r %u&h h"u%ing during rem"deling3 in&luding m"% h"u%e (uil (e#"re 11603 and %e,eral h"me (uild u' " 1170? h"%e 5h"%e %i(ling% "r " her &l"%e 'eer% ha,e lead '"i%"ning? and h"%e 5h"%e h"u%eh"ld mem(er% ha,e lead+rela ed "&&u'a i"n% "r h"((ie%3 "r 5h" li,e near lead+rela ed indu% rie% 6!D!3 -01-8) S&reening e% % are u%ually d"ne "n (l""d &"lle& ed #r"m #inger "r heel 'un& ure) 4he ,eni'un& ure (l""d e% i% needed " &"n#irm he diagn"%i%) O her e% % ha may (e hel'#ul in de ermining he 're%en&e "# lead in he ("dy are? radi"gra'h% "# he a(d"men " hel'

LEAD POISONING

10

de e& he 're%en&e "# lead 'ain &hi'%? radi"gra'h% "# he l"ng ("ne% #"r lead line% &au%ed (y de'"%i i"n "# lead? (l""d % udie% #"r e,iden&e "# anemia 6!F!3 re i&ul"&y e &"un %8? and a lead m"(iliHa i"n e% " hel' 'redi& he am"un "# lead ha may (e rem",ed (y &hela i"n 6Ge"rge3 Heeney ; *""l#3 -0108) anagement of Lead Poisoning and the Role of !urse Practitioner' 4he !D! re&"mmend% 'er#"rming lead %&reening in &hildren a age 6 m"n h% " 6 year%3 and ,eni'un& ure a age 1- and -4 m"n h%) All he ele,a ed lead le,el% mu% (e re'"r ed " he l"&al 'u(li& heal h de'ar men ) 4he &hildE% (l""d lead le,el de ermine% he degree "# ri%0 and he y'e "# in er,en i"n) 4he aim "# managemen i% " elimina e lead in he ("dy and a,"id he addi i"nal (uildu' "# me al) 4hera'eu i& m"dali ie% in&lude rem",ing he %"ur&e "# lead3 im'r",ing nu ri i"n3 and u%ing &hela i"n hera'y 6A(el%"hn ; San("rn3 -0108) *i h em'ha%i% "n early de e& i"n "# l"5 (l""d lead le,el%3 eradi&a ing %"ur&e% "# lead in he en,ir"nmen i% he g"al) On&e lead '"i%"ning i% diagn"%ed3 rea men % ar % 5i h re e% ing " &"n#irm he re%ul %3 and "rdering &"m'le e (l""d &"un and #erri in le,el " rule "u ir"n de#i&ien&y) A de ailed hi% "ry "# e<'"%ure %h"uld (e a0en " de ermine n"n+'ain lead e<'"%ure3 rem",e he &hild immedia ely #r"m he %"ur&e "# he '"i%"ning3 %u&h a% h"u%e un il he h"u%e ha% (een &leaned u' "r he %i ua i"n ha% a(a ed " 're,en &"n inuing e<'"%ure) Ir"n %u''lemen a i"n 4+6 mg.0g.daily i% 're%&ri(ed i# he &hild i% ir"n de#i&ien ) A&&"rding " A(el%"hn ; San("rn 6-0108 ir"n %u''lemen a i"n i% a neur"+'r" e& i,e (y de&rea%ing ga% r"in e% inal lead a(%"r' i"n) !al&ium and Hin& %u''lemen a i"n may al%" (e gi,en i# indi&a ed)

LEAD POISONING

11

!hela i"n hera'y i% u%ually re%er,ed #"r &hildren 5i h high (l""d lead le,el%) Drug% ha may (e u%ed are &al&ium di%"dium ede a e 6!aNa-ED4A "r !aED4A83 dimer&a'r"l al%" &alled FAL @Fri i%h an le5i%i eA3 and dimer&a' "%u&&ini& a&id 6DS9A8 6%u&&imer @!heme A 6Ge"rge3 Heeney ; *""l#3 -0108) Peni&illamine 6!u'rimine3 De'en8 i% u%ed (y %"me 'ra& i i"ner% " &hela e &hildren 5i h m"dera e le,el% "# lead) 4he e<a& &"ur%e "# hera'y de'end% "n he %e,eri y "# he &hildE% &"ndi i"n and he 'ra& i i"nerE% 're#eren&e) !"m(ina i"n hera'y 5i h !aED4A and FAL d"e% n" %eem " re%ul in (e er re%'"n%e (u d"e% in&rea%e drug "<i&i y 64" " e al)3 -01-8) !aNa-ED4A i% gi,en 're#era(ly in ra,en"u%ly? in ramu%&ular inGe& i"n% are ,ery 'ain#ul) FAL 6're'ared in 'eanu "il8 i% gi,en "nly in ramu%&ularly and i% al%" a ,ery 'ain#ul inGe& i"n 6Ge"rge3 Heeney ; *""l#3 -0108) D+Peni&illamine and %u&&imer are admini% ered "rally) !hildren 5h" need " re&ei,e &hela i"n hera'y are 're'ared #"r he inGe& i"n% and all"5ed " e<'re%% heir anger and 'ain) Heal h &are 'r",ider need% " e<'lain " &hild "# he need #"r rea men " heir under% anding? 'rin&i'ally ha i i% n" 'uni%hmen ) *i h he in&rea%e u iliHa i"n "# h"me "ral &hela i"n hera'y3 i i% im'"r an " edu&a i"n he 'aren % " gi,e he medi&a i"n a% dire& ed) *hen gi,ing !hela ing agen % admini% er inGe& i"n dee'ly in " a (ig mu%&le ma%% (e&au%e i i% 'ain#ul) 4he l"&al ane% he i& Pr"&aine &an (e gi,en 5i h !aNa-ED4A " le%%en he 'ain) I i% al%" im'"r an " al erna e %i e% "# inGe& i"n " a,"id he de,el"'men "# 'ain#ul area% "# #i(r" i& i%%ue 6Ge"rge3 Heeney ; *""l#3 -0108) Sym' "ma i& rea men during &hela i"n hera'y in,"l,e% "(%er,ing #"r and &"n r"lling %eiHure #"r 5hi&h he &hild i% a ri%0 and a0ing mea%ure% " redu&e he %ide e##e& % "# %"me "# he medi&a i"n%3 %u&h a% he nau%ea ha &an "&&ur 5i h FAL) De'ending "n he drug (eing u%ed3 %erum ele& r"ly e le,el% %h"uld (e a0en a 're%&ri(ed in er,al%3 urine %'e&imen% analyHed3 and

LEAD POISONING

1-

#luid in a0e and "u 'u mea%ured) I# numer"u% 'ain &hi'% are ,i%i(le in he ga% r"in e% inal ra& "n radi"l"gi& e<amina i"n3 &lean%ing enema% "r a &a har i& may (e "rdered) E,ery e##"r i% made " 're,en in#e& i"n and main ain adeDua e hydra i"n) *hen %u&&imer i% gi,en3 adeDua e #luid in a0e i% e%'e&ially im'"r an 3 a% i% &l"%e m"ni "ring "# he a(%"lu e neu r"'hil &"un ) Neu r"'enia &an "&&ur during drug hera'y) I# nu ri i"nal de#i&ien&ie% &"e<i% 3 hey are rea ed a''r"'ria ely3 %u&h a% 5i h he admini% ra i"n "# %u''lemen al ir"n #"r ir"n de#i&ien&y anemia) Ir"n %h"uld n" (e gi,en during &hela i"n3 h"5e,er3 e%'e&ially 5i h FAL (e&au%e "# '"%%i(le in era& i,e e##e& %) Prognosis) Al h"ugh m"% "# he 'a h"'hy%i"l"gi& e##e& % "# lead are re,er%i(le3 he m"% %eri"u% &"n%eDuen&e% "# (" h high and l"5 lead e<'"%ure% are he e##e& % "n he &en ral ner,"u% %y% em) In &hildren 5i h lead en&e'hal"'a hy3 'ermanen (rain damage &an re%ul in men al re arda i"n3 (eha,i"r &hange%3 '"%%i(le 'araly%i%3 and %eiHure%) H"5e,er3 m"dera e " l"5+d"%e e<'"%ure may al%" &au%e 'ermanen neur"l"gi& de#i&i %) C"ung &hildren 5i h (l""d lead le,el% a,eraging 4/ mi&r"gram%.dl3 5hen e% ed a% y"ung adul %3 had m"re a&ademi& 'r"(lem% 6reading di%a(ili ie%3 %&h""l #ailure%83 '""r &""rdina i"n 6hand+eye m",emen %3 #inger a''ing83 and a higher in&iden&e "# min"r delinDuen&y han &hildren 5i h l"5er (l""d lead le,el% 6Hea,ey3 -0078) $"r a &hild 5i h a (l""d lead le,el a(",e -0 ug.dl3 neur"l"gi&al and '%y&h"l"gi&al e,alua i"n and #"ll"5+u' i% re&"mmended)

Conclusion Pre,en i"n "# ini ial e<'"%ure "r #ur her e<'"%ure " lead '"i%"ning i% he main nur%ing g"al) 4hi% u%ually reDuire% de e& ing he %"ur&e% "# lead in he %urr"unding% #"r 0id% 5i h l"5+

LEAD POISONING

1/

le,el e<'"%ure) !are#ul hi% "ry a0ing i% "ne "# he m"% u%e#ul3 e%'e&ially h"%e rela ed " he h"me en,ir"nmen ) 4he "<i&i y "# lead and !aNa -ED4A " he 0idney 5arran % im'"r an&e "# m"ni "ring in a0e and "u 'u 3 urinaly%i% d"ne #reDuen ly " &he&0 0idney #un& i"ning) 4ea&h %a#e y 're&au i"n #"r %eiHure and #all #"r &hildren 5i h high (l""d lead le,el%) Heal h &are 'r",ider %h"uld in% i u e a''r"'ria e re#erral% #"r #amilie% a he highe% ri%0 #"r lead '"i%"ning ha la&0 re%"ur&e% " &"m'ly 5i h mea%ure% %u&h a% rel"&a i"n "r de+leading he h"me)

Re#eren&e% A(el%"hn3 A) R)3 ; San("rn3 9) 6-0108) Lead and &hildren &lini&al managemen #"r #amily 'hy%i&ian%) Canadian Family Physician, 56 6683 >/1+>/>)

LEAD POISONING

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!en er #"r Di%ea%e !"n r"l and Pre,en i"n) 6-01-8) Low level exposure harms children: A renewed call for primary prevention) Re'"r "# he Ad,i%"ry !"mmi ee "n !hildh""d Lead '"i%"ning Pre,en i"n) Re rie,ed #r"m 555)&d&)g",.n&eh.lead.a&&l''.#inalNd"&umen N0/021-)'d# Ge"rge3 9)3 Heeney3 9) 9)3 ; *""l#3 A) D) 6-0108) En&e'hal"'a hy #r"m lead '"i%"ning ma%Duerading a% a #lu+li0e %yndr"me in an au i% i& &hild) Pediatrics Emer ency Care, !6 6>83 /20+/2/) Hea,ey3 E) 6-0078) Lead '"i%"ning in &hildren: S ill a hrea ) "ursin , #$ 61-83 12+17) 4" "3 9)3 De Gia&"m"3 A)3 Pe ruHHelli3 9) G)3 Di&u"nH"3 $)3 San "r"3 N)3 Del Le&&hi"3 G) !)3 !raig3 $)3 ; 9argari3 L) 6-01-8) Gullain+Farre+li0e %yndr"me in a &hild 5i h lead '"i%"ning) "europediatrics, %#3 -12+--0) *illiam%3 E)3 Lander%li&e3 R)3 ; $eliH3 !) F) 6-01-8) Analy%i% "# (l""d lead %&reening da a 6-007+-0118 #"r re#ugee &hildren in Rh"de I%land) &edicine and 'ealth, (hode )sland 1> 6483 1-1+1/0)