1) Describe the selected environmental factor-Lead poisoning. Explain how the environmental factor you selected can potentially affect the health or safety of infants.

2) Create health promotion plan that can be presented to caregivers to address the environmental factor and improve the overall health and well-being of infants.

3) Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants.

4) Offer examples, interventions, and suggestions from evidence-based research. At least three scholarly resources are required. Two of the three resources must be peer-reviewed and no more than 6 years old.

5) Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource.

 

Lead is a metal that occurs naturally in the earth's crust. It can be found everywhere in the environment. Much of it comes from human activities such as mining and industry. Lead used to be present in paint. Older homes may still be painted with paint that contains lead. You can be exposed to lead by:

 

Eating lead-contaminated food or water. Water pipes in older homes may contain lead

Work in a job where lead is used

Have a hobby that uses lead, such as making stained glass or lead-glazed pottery

Using home remedies, such as herbs or foods that contain lead

Breathing air, drinking drinking water, eating food, or swallowing or touching things that are contaminated with lead can cause many health problems. Lead can affect almost every organ and system in the body. In adults, lead can increase blood pressure and cause infertility, nerve disorders, and muscle and joint pain. It can also make you irritable and affect your ability to focus and remember.

 

Lead is especially dangerous for children. A child who ingests large amounts of lead can develop anemia, severe stomach pain, muscle weakness, and brain damage. Even at low levels, lead can affect a child's physical and mental growth.

 

Lead poisoning is a major environmental problem in the US and around the world. Although the average level of lead in blood has declined in the past decade, poisoning is still a threat to children. In 2001, the first death due to this poisoning in many years was reported in the USA. Thousands more are affected by this disease.

 

Lead is found in all societies. It is airborne due to pollution, which has been a major contributor to poisoning in recent times in the US Most of it is due to emissions from automobiles that use leaded gasoline. In the 1970s the US government began taking steps to reduce its use. The Clean Air Act completely removed lead from gasoline in 1992.

 

Industrial activities also pollute the air. Lead smelters and companies that burn solid waste also provide local pollution. Battery recycling plants can emit lead into the atmosphere, since batteries have a high content of lead. The air from these factories threatens children in the vicinity who inhale lead dust.

 

In addition, airborne lead settles on the ground and continues to pollute the environment for years. Crops can become contaminated by airborne lead due to pollution. Some vegetables or fruits grown at home, in "urban gardens", can become contaminated in this way. Lead in crops declined in the 1980s due to federal restrictions on the content allowed in industrial pollution.

 

Lead in food can also contribute to poisoning. Canned food can be contaminated by lead solder in cans. This was a major source of contamination in the US until federal law restricted the amount of lead allowed. In 1980, 47% of cans in the US had lead solder. In 1989, only 1.4% kept this type of welding. Canned food imported from other countries may still have it.

 

Another source of lead in food is related to the use of dishes with improperly applied lead glazes. For example, Mexican pottery has proven to be a source of contamination. The risk is especially high if acidic fluids are stored in such dishes, as they will cause lead to leak from the glazes. It is recommended not to store food in lead glass or pottery, and certainly not to feed babies with preparations packed in lead glass. It is said that the excessive consumption of lead from drinking containers may have contributed to the fall of the Roman Empire.

 

Water is a source of lead in many societies. In the USA it has not contributed significantly to this poisoning. However, many houses built after 1950 may have lead solder in their pipes. This implies risk of exposure. This can be reduced by letting the water flow (flushing the pipes) before use. Those who live in homes with lead pipes are also advised to draw from cold water taps (not hot water taps) because lead filters less than the first. Government regulations (Safe Water Act, 1986) prohibit the use of lead in water distribution systems and limit its content in brass materials used for plumbing.

 

Lead-based paint has been the largest source of lead poisoning in children in the US.

 

Lead additive paints were preferred for years, and were the most expensive. Many properties were painted with lead-based paints in their 30s and 40s. This was not a threat to the children until the properties deteriorated. In 1977 the Consumer Product Safety Commission banned the use of lead in paint for new residences, although these paints were still for military and industrial use. However, many older homes still have this type of paint. Many are worn, so peeling paint is accessible to younger children. It is estimated that about 74% of private homes (57 million homes built before 1980) have lead-based paint. In 1990, an estimated 14 million homes had high levels of lead in lead dust or lead-based paint that was deteriorating. The youngest children live in about 3.8 million of these households.

 

Children can be poisoned by eating small pieces of paint that falls from walls, or wooden surfaces, to the floor. Lead, in the form of dust from damaged surfaces in those homes, most often contaminates children's hands and toys. Hand-to-mouth contact results in chronic ingestion of lead dust.

 

Particles from exterior surfaces painted with lead-based paint can also fall to the ground outside the home. This provides a long-term source of contamination: while children play in the dirt they can ingest lead from their contaminated hands. Many bridges in the US are painted with lead-based paint, and periodic repairs and cleaning of these bridges release particles that pose a risk to neighboring children because they contaminate the land where they play.

 

There are many other, less common but important sources of contamination for children and adults. Inhalation of lead naphtha vapors can cause severe acute toxicity and even death. This was a problem in the US, when teens deliberately inhaled gasoline before it was lead-free. Some hobbies can cause exposure to the poison, such as furniture restoration or stained glass work. Some household items contain lead, such as painted furniture, brass fixtures, and blinds. Some cosmetics contain lead. It is also found in sinkers used for fishing, and is placed inside curtains to keep them stretched. The death of an infant was reported after ingestion of a weight placed on a curtain that had fallen to the ground. Lead-contaminated toys often end up in children's mouths. The Consumer Product Safety Commission carefully inspects all toys made in the US to limit the amount of lead. But even today, some imported toys are a threat until recognized. Unfortunately some toys, like tin soldiers and imported crayons from China, are contaminated with lead. Some traditional medicines, mineral supplements and spices imported from Arab and Asian countries are also contaminated.

 

Finally, children and adults can be poisoned after being shot by bullets containing lead. If the bullet lodges in an area bathed by synovial or cerebrospinal fluid, it can dissolve after a long period of time, slowly raising the level of lead in the blood. If it is lodged in the muscle, the problems are less frequent, since the scar tissue surrounds it.

 

In short: there are numerous sources of lead in the world. Within these, six categories account for the most cases: naphtha additives, can solders, lead-based paint, contaminated drinking water systems, ceramic glazes, and traditional medicines.

 

Children are at the highest risk for lead poisoning. They are closer to the ground and are more likely to ingest or inhale particles that fall to the ground. More importantly, between 1 and 6 years old, foreign objects are frequently placed and fingers and hands are inserted into the mouth. This can result in chronic poisoning if they are contaminated with lead dust. Poor minority children in the US are disproportionately affected by this toxicity. They are more likely to live in older homes, with deteriorated paintings. The latest data shows that low-income children living in older homes have a prevalence of 30mg / de in blood lead levels compared to middle-income children living in more modern homes. It has recently been estimated that close to one million children in the US are at risk of poisoning due to poor paint conditions in old houses.

 

Lead absorption increases when the contribution of other minerals in the diet is inadequate. Thus those with iron, calcium or zinc deficiency are at greater risk of poisoning. Dietary calcium competitively inhibits active intestinal lead transport. (Lead seems to be absorbed by the same pathway as the mechanisms developed for the absorption of essential elements, such as Fe, Ca and Zn)

 

Hematological effects

 

Lead poisons the mitochondria. Anemia can result from impaired heme synthesis. Lead inhibits the red blood cell enzyme delta aminolevulin dehydratase. It also inhibits ferrochelatase and thus prevents the incorporation of Fe into protoprofyrin to form the heme molecule. In a lead poisoned child, however, the anemia is caused more by iron deficiency, which occurs concomitantly.

 

Signs / Symptoms of Lead Poisoning

 

Most poisoned children are asymptomatic. Less than 5% of children are diagnosed as intoxicated based on clinical presentation. The toxic effect is related to the concentration in blood and soft tissues. This normally constitutes only 5% of the total body lead load, since most of it (90-95%) is stored in bone.

 

Lead encephalopathy had been reported regularly in the 1950s to 1960s. When blood lead levels reached excessive levels (greater than 100µg / dl), coma and seizures developed. They were often fatal cases. Severe and permanent brain damage (ataxia, apathy, loss of acquired skills) was demonstrated in 70-80% of the survivors. In these cases, the examination revealed increased intracranial pressure. Fortunately, after monitoring and restricting the use of lead, encephalopathy is very rare today. It is still a cause of mortality in other countries.

 

Chronic lead poisoning more frequently causes less severe symptoms such as: lethargy, anorexia, constipation, vomiting, and abdominal pain. Peripheral neuropathy is possible, but very rare in children (more frequently in those associated with sickle cell anemia and lead poisoning).

 

In recent years she has focused on the subtle but deteriorating effects of lead on cognitive function in young people. Levels much lower than those that cause digestive or neurological symptoms can affect a child's behavior and cognitive function.

 

Needleman et al. Published a major study in the New England Journal of Medicine (NEJM) in 1979. These researchers collected the temporary teeth of 2,300 1st graders. and 2nd grade. They measured lead levels in dentin (lead stored in teeth) and compared the 58 children with the highest levels to 100 children with the lowest levels. None of them had obvious poisoning. They found that higher levels of lead correlated with lower scores on Weschler intelligence tests, lower scores on verbal subtests, and poorer adaptive behavior in class. In 1990 they published another study in the NEJM. They looked for the children from the previous study, 11 years later, obtaining participation from 132 of them. They found that those with higher levels of lead in dentin had more difficulty graduating from high school, more reading difficulties, increasing absenteeism, scored less on vocabulary tests and had lower averages in their class. They also had longer reaction times and poorer hand-eye coordination. This study implied that the deleterious effects of subclinical lead poisoning were serious and long-lasting.

 

In 1988, McMichael and colleagues measured the blood lead level of 700 pregnant women in Australia, and the lead levels in the umbilical cord of babies at birth. They then tested these children intermittently until they were 2 years old. These researchers found an inverse relationship between average blood lead concentration in early childhood and cognitive development. An increase in blood lead of 10 to 30 µg / dl was associated with a 7-point decrease in intelligence tests at the age of 4 years.

 

Bellinger et al., In a similar study in 1987, obtained lead levels in 250 umbilical cords of children, children of middle and upper-middle class parents. The researchers repeated the measurement of lead levels prospectively during the first two years of life. Lead levels were between 10-25 µg / dl. They found that pre- and postnatal lead exposure was linked to altered performance on the Bayley Mental Development Index at 6 months, and through the 2nd year of life.

 

In 1991, Bellinger et al. Rechecked 170 of the above children. They periodically looked for lead levels and took developmental tests until the children were 5 years old. They found that around 57 months the inverse relationship between blood lead level at birth and developmental test scores had declined in importance.

 

However, the highest levels at 24 months were inversely related to developmental test scores at 57 months. Higher-class children had a better chance of recovery from early developmental problems.

 

Studies published in the last year involving children with blood levels of 20-44 µg / dl, imply that the neuro-cognitive effects of chronically elevated blood levels are irreversible. Even with chelation, there is no beneficial effect on cognitive or behavioral measures.

 

In sum, several studies show that blood levels above 10 µg / dl can affect the cognitive. In general, about one-quarter to one-half of the IQ score is lost for every µg / dl that blood lead increases during the preschool years. The threshold beyond which the relationship between lead level and IC is discernible is unknown.

 

Lead has serious consequences on the health of children. If the degree of exposure is high, it attacks the brain and the central nervous system, which can cause coma, seizures and even death. Children who survive severe poisoning can suffer from various sequelae, such as mental retardation or behavioral disorders.

 

It has also been proven that at lower levels of exposure without obvious symptoms, lead can cause very diverse alterations in various systems of the human body. In children, it can affect brain development in particular, which in turn leads to reduced IQ, behavioral changes - for example, decreased ability to concentrate and increased antisocial behaviors - and decreased performance school.

 

Exposure to lead can also cause anemia, hypertension, kidney dysfunction, immunotoxicity, and reproductive toxicity. The neurological and behavioral effects associated with lead are believed to be irreversible.

 

There is no level of lead concentration in the blood that can be considered risk-free. Even a blood level of 5 µg / dl can affect children's intelligence and cause behavior problems and learning difficulties. The higher the level of exposure, the more the diversity and severity of symptoms and associated effects increase.

It is encouraging that the phasing out of leaded gasoline in most countries, coupled with other measures, has significantly reduced lead levels in people's blood. Currently only one country continues to use this type of fuel. However, we must continue to phase out lead paints as, so far, only 37% of countries have introduced mandatory regulatory measures in this regard.

 

From a chemical point of view, the detection and removal of lead is very important, both for public health and for the environment. The big problem is the Pb2 + cations, since this cation is in solution and is very difficult to detect and eliminate, because it is normally found in low concentrations, but already under these conditions it is very toxic.

 

The methods for detecting and removing lead can be classified into traditional and modern.

 

Traditional methods are based on the formation of insoluble compounds and their subsequent elimination by precipitation. These methods have a number of drawbacks:

a) high detection limit

b) high reagent consumption

c) null selectivity.

 Most modern methods are based on the use of sensors, a great variety of these are known depending on the element to be detected and the price. There are two methods that are current and effective for the detection of Pb2 + and that have a perfectly affordable cost.

These two methods are:

a) biomimetic, they are colorimetric sensors

b) they contain aroylthiourees as ionophores, they are potentiometric sensors.

 

Other methods are in the research phase are those that use nanostructured hybrid materials, they are based on substitution or ion exchange reactions. These methods stand out for being cheap, biodegradable and with the particularity that in addition to eliminating Pb2 + they can eliminate organic contaminants. They are currently under study and present a series of drawbacks: a) pH ˜ 4 b) time ˜ 30 min c) interference with other ions, among others n These methods are applied and designed to be used in industry and in particular in the treatment of polluted water.

 

In the medical field there is currently no method that is valid and effective to detect and eliminate Pb2 + in the body. It is believed that one of the fields to be developed is nanomedicine, so efforts are being focused on this research, which could be useful to detect and subsequently eliminate the Pb2 + accumulated in the body, but this technique is currently in phase research.

 

How health promotion can be designed:

In previous risk assessment studies, it was established that soil could contribute 87% of the Pb dose in exposed children4. Therefore, the main message for the children was "Don't eat dirt", along with messages for other preventive behaviors when handling dirt, such as "You should wash your hands", "After playing with dirt, wash your toys", "Don't suck on toys." In addition, the PCR included messages for other routes of exposure to Pb, such as the use of glazed clay pots for cooking, sucking on pencils and colors with lead-based paint, among these "Do not eat beans cooked in glazed clay pots", "Don't suck on pencils or colors." Also included were messages related to ways to reduce or counteract the damages caused by Pb and As, so other messages were, "You must drink milk", "You must eat cheese and yogurt". Parents were given messages regarding the prevention of exposure to pollutants, such as "You should clean the dust inside your home", "You should avoid cooking in glazed clay pots", "You should offer dairy products to your family "," You should be careful with your children's recreational activities "and" You should drink purified water ".

 

Drawings and quizzes to children

 

A Chi-square test was carried out to know the proportions of the elements found in the drawings and the correct answers of the questionnaires.

 

Parent questionnaires

 

With these questionnaires, it was possible to compare the behaviors of the children before and after the CRP through a Chi-square test.

 

Biological monitoring

 

In the case of the variable PbS a normal behavior was followed, and in the case of AsO a logarithmic transformation was carried out, with this transformation the data were normalized and the parametric analysis was continued for both variables. The tests carried out were descriptive statistics, T-paired to compare the average values ??of the first to the second biological sampling and thus a repeated measurements ANOVA test was performed in order to know if the decrease or increase of each individual per sample it was statistically significant. Statistica software was used for this analysis.

 

Another point that deserves to be commented is the fact of working with numerically small populations. In our work, the small sample was due to ethical issues of working only with those children whose parents authorized three samplings of their children. Small numbers always imply a statistical limitation, but in many cases, like ours, this is not serious if we consider the variability.

 

As for prevention

It is imperative to prevent lead poisoning, since the learning and behavioral effects of lead poisoning can be permanent despite treatment. The first rule of thumb is to reduce lead exposure. Efforts should be directed at recognizing and eliminating polluting sources of lead. Professionals trained in the use of special instruments to detect lead on walls and other surfaces can inspect homes. High friction surfaces such as doors and windows are at risk of peeling paint. Window frames, which children frequently chew on, should also be inspected. Efforts should be made, where possible, to reduce the habit of putting objects in the mouth or to insist on frequent washing of hands and toys in children with this habit. It is also important to ensure good nutrition, especially with diets rich in iron and calcium, to limit the absorption of lead. Lead chelators may be necessary.

 

The role of the pediatrician is to educate parents to reduce lead exposure, perform tests on children with symptoms, interpret blood lead dosages, coordinate plans with health personnel, secure medical treatment when necessary, and coordinate aftercare. If iron deficiency is found, it should be supplemented. There is no evidence that iron with added vitamins is helpful for the child without iron deficiency, and there is no evidence that daily supplementation of calcium tablets is beneficial.

 

Parents must ensure the child a balanced diet. A quarter liter of milk per day or calcium-fortified orange juice (one gram of calcium per day) is recommended. Parents should keep children from chipping lead paint, chewing surfaces, such as window frames. A simple step like moving the crib away from areas of flaking paint can help reduce lead dust by wetting contaminated surfaces weekly with a high-phosphate solution. It is important that children wash their hands before eating and wash toys daily. Also, if lead paint is present, parents can plant shrubs around the home to keep children away from contaminated soil. Tap water must circulate before use. Parents should not store food in metal containers or use decorative dishes. They should avoid bringing lead-contaminated clothing home as a result of handling lead-containing materials.

 

The Ministry of Public Health should be responsible for inspecting homes for lead paint and ensuring screening of children from high-risk communities. The Ministry of Health should ensure the abatement of lead in homes when necessary. This is an expensive and complex procedure that must be done properly or lead poisoning will continue dramatically.

 

This task should be carried out exclusively by trained personnel and the family should be out of the home when this work is performed. Workers must be protected, as lead dust can poison them. Items in the home should be covered with plastic during repairs to prevent lead build-up.

 

Lead paint can be removed. If this is not possible it can be covered with other paints. In other situations, lead can be removed with chemicals, heat, or mechanically. It is a tedious procedure that generates dust. It is essential that after doing this work the house is cleaned with vacuum cleaners with an air filter. Wetting and washing surfaces also helps reduce the amount of lead dust.

 

Clean dusty surfaces. Clean floors with a damp mop and wipe furniture, window frames, and other dusty surfaces with a damp cloth.

 

Take off your shoes before entering the house. That will help you keep the leaded soil out.

 

Run cold water. If your plumbing contains lead pipes or fittings, run cold water for at least a minute before using them. When you cook or prepare formula for your baby, do not use the hot water from the tap.

Prevent children from playing with dirt. Offer them a litter box that can be covered when not in use. Sow grass or mulch the soil.

 

Eat a healthy diet. Regular meals and good nutrition may help reduce lead absorption. Children, in particular, need a sufficient amount of calcium, vitamin C, and iron in their diets to help them not absorb lead.

Keep your home tidy. If your home has lead-based paint, check it periodically for peeling paint and fix problems immediately. Try not to sand as this creates dust particles that contain lead.

 

Here is an article based on evidence where he intervenes in the design of investigations regarding lead poisoning of children:

 

Lead poisoning is a major environmental problem in the US and around the world. Although the average level of lead in blood has declined in the past decade, poisoning is still a threat to children.

Lead Poisoning Diagnosis

 

It should be suspected in young children living in high-risk environments. The priority of cases includes children who live in dilapidated houses recycled before 1960, those with relatives who have lead poisoning, those who live near lead smelters or battery recycling plants, who have relatives whose work is related to lead or have hobbies that handle lead.

 

Although the combination of abdominal pain, anorexia, and constipation may suggest the diagnosis, these symptoms are very nonspecific. Since most children with lead poisoning are asymptomatic, it is imperative to do a blood dose to confirm the diagnosis.

 

Investigation of lead poisoning should begin in children at one year of age and repeat at two years of age. Blood lead levels increase by two years of age as children gain mobility and bring objects to their mouths. All children living in high-risk areas should be investigated. High-risk areas in the US include: geographic areas with high lead content, areas with large numbers of homes built before 1959, areas with high-risk groups such as the homeless, urban populations, young children, and areas that have high number of intoxicated children. In addition, those children who are detected foreign bodies in the nose, ear and digestive tract, may have a greater risk of poisoning. These children may also have itches. A questionnaire such as the one below should be used to identify children at high risk for lead poisoning:

 

Basic personal risk questionnaire

 

1) Does your child live in or regularly visit a home or daycare built before 1950?

YES | NO

 

2) Does your child live in or regularly visit a home or nursery built before 1978 that has recently been renovated or refurbished (in the last 6 months)?

YES | NO

 

3) Does your child have a relative or playmate who has or has had lead poisoning?

YES | NO

 

The sensitivity of a questionnaire such as this to identify a child with lead poisoning is about 60-70%.

 

Venous blood samples are best for measuring blood lead levels. Capillary blood samples are inaccurate, especially if the child's finger is not cleaned properly. If the technique is correct, it can be well correlated with venous blood levels. A blood level of 10 µg / dl (0.48 µmol / L) or higher should be considered elevated. Those with levels between 10 and 19 µg / dl should repeat the study in a few months. Those with high levels repeatedly and with levels greater than 20 µg / dl should have a clinical and nutritional evaluation. Their houses and their surroundings must be inspected. Some consider treatment with chelators with levels above 25 µg / d.

 

A level greater than 44 µg / dl is an indication for treatment with chelators urgently. A level above 70 µg / dl requires immediate hospitalization and treatment with chelators. It is important to remember that lead is measured in the blood, but most of it in the body is stored in the bone.

 

Monitoring of children

lead poisoned

 

X-rays have limited use in lead poisoning. An abdominal X-ray can reveal lead paint particles in the stomach, but this is rare since most children develop lead poisoning from chronic ingestion of lead-contaminated dust. Long bone radiography may show increased density at the level of the metaphyses (lead lines) but is not reliable. The study of nails and hair correlates poorly with blood dosages and is not useful in the clinic, therefore it is not recommended. A new technique, called fluorescent X-rays, measures the lead contained in bone (where most of the lead is stored) but the use of this technique is limited to research work.

 

Management and prevention of

lead poisoning

 

It is imperative to prevent lead poisoning, since the learning and behavioral effects of lead poisoning can be permanent despite treatment. The first rule of thumb is to reduce lead exposure. Efforts should be directed at recognizing and eliminating polluting sources of lead. Professionals trained in the use of special instruments to detect lead on walls and other surfaces can inspect homes. High friction surfaces such as doors and windows are at risk of peeling paint. Window frames, which children frequently chew on, should also be inspected. Efforts should be made, where possible, to reduce the habit of putting objects in the mouth or to insist on frequent washing of hands and toys in children with this habit. It is also important to ensure good nutrition, especially with diets rich in iron and calcium, to limit the absorption of lead. Lead chelators may be necessary.

 

The role of the pediatrician is to educate parents to reduce lead exposure, perform tests on children with symptoms, interpret blood lead dosages, coordinate plans with health personnel, secure medical treatment when necessary, and coordinate aftercare. If iron deficiency is found, it should be supplemented. There is no evidence that iron with added vitamins is helpful for the child without iron deficiency, and there is no evidence that daily supplementation of calcium tablets is beneficial.

 

Parents must ensure the child a balanced diet. A quarter liter of milk per day or calcium-fortified orange juice (one gram of calcium per day) is recommended. Parents should keep children from chipping lead paint, chewing surfaces, such as window frames. A simple step like moving the crib away from areas of flaking paint can help reduce lead dust by wetting contaminated surfaces weekly with a high-phosphate solution. It is important that children wash their hands before eating and wash toys daily. Also, if lead paint is present, parents can plant shrubs around the home to keep children away from contaminated soil. Tap water must circulate before use. Parents should not store food in metal containers or use decorative dishes. They should avoid bringing lead-contaminated clothing home as a result of handling lead-containing materials.

 

The Ministry of Public Health should be responsible for inspecting homes for lead paint and ensuring screening of children from high-risk communities. The Ministry of Health should ensure the abatement of lead in homes when necessary. This is an expensive and complex procedure that must be done properly or lead poisoning will continue dramatically.

 

This task should be carried out exclusively by trained personnel and the family should be out of the home when this work is performed. Workers must be protected, as lead dust can poison them. Items in the home should be covered with plastic during repairs to prevent lead build-up.

 

Lead paint can be removed. If this is not possible it can be covered with other paints. In other situations, lead can be removed with chemicals, heat, or mechanically. It is a tedious procedure that generates dust. It is essential that after doing this work the house is cleaned with vacuum cleaners with an air filter. Wetting and washing surfaces also helps reduce the amount of lead dust.

 

Medical treatment

 

Chelating agents

 

Succimer (dimercaptosuccinic acid) is the newest and most widely used agent for the treatment of lead poisoning, as it can be easily dosed orally. This drug promotes urinary lead excretion. It is administered orally at 350mg / m2 dose (not exceeding 10mg / kg) every 8 hours for five days and then every 12 hours for fourteen days. It can be mixed with food as it has a slight metallic taste. Side effects are: nausea, vomiting, diarrhea, anorexia, rash, and neutropenia.

 

CaNa2 EDTA (ethylenediaminetetraacetic acid) is another chelating agent used for many years for the treatment of lead poisoning. It also increases urinary lead excretion. It is administered intravenously or intramuscularly at a dose of 1,000 to 1,500 mg / m2 / day every 6 to 12 hours for five days. Side effects and toxicity include impaired renal function (dose dependent, reversible), proteinuria, hematuria, and transient effects on the liver. The drug is contraindicated in patients with anuria.

 

BAL (dimercaprol), or British AntiLewisite, is another chelating agent reserved for the most severe cases of lead poisoning (blood levels greater than 70 µg / dl). This agent combines with heavy metals and promotes their fecal and urinary excretion. It should be administered intramuscularly every 4 hours for 3 to 5 days. The dose is 300 to 500 mg / m2 per day. Side effects are fever, hepatotoxicity, vomiting, hypertension, headaches, and mental confusion. The injection is very painful. It is contraindicated in patients with peanut allergy and in patients with glucose-6-phosphate dehydrogenase deficiency. BAL cannot be administered with an iron supplement as it forms a toxic compound that causes vomiting and liver failure.

 

D-penicillamine is rarely used as a chelating agent.

 

Treatment protocol

 

Lead level between 25 and 44 µg / dl

 

It is controversial to consider chelating agents.

 

Lead level between 45 and 69 µg / dl

 

Administer succimer. Perform complete blood count, liver function and lead dosage weekly. During the treatment, detect the rebound increase in blood lead between 7 and 10 days after the end of the treatment.

 

Lead level greater than 69 µg / dl

 

Add a second chelating agent to the succimer. The child must be admitted for the use of intravenous CaNa2 EDTA. Adequate hydration must be ensured by maintaining a urinary density of 1.015 or less to minimize the risk of nephrotoxicity. Daily urinary ionogram, creatinine, calcium and phosphorus. Hemogram and sideremia during treatment. The rebound increase in blood is possible after 7 to 21 days of treatment.

 

If succimer is not tolerated, administer BAL plus CaNa2 EDTA with an interval of 4 hours between the two. This is recommended since children with high blood lead levels can be aggravated if CaNa2 EDTA is administered alone. Continue with BAL every 8 hours. If the level of lead in the blood is higher than 100 µg / dl, carefully observe signs of intracranial hypertension.

 

In all cases try to keep the child out of the house until the lead sources are removed. Remember that chelating agents remove lead from the blood so that, although lead exposure is controlled, the increase in blood lead levels invariably occurs within a few weeks, as lead is removed from bone and soft tissues. For children with blood lead levels above 100 µg / dl it can drop to 45 µg / dl in a few days. For those with lower levels it can drop to two-thirds of the baseline value in four to six weeks.

 

Subsequently, the use of chelating agents may be necessary.

 

Key words: LEAD POISONING - diagnosis

  LEAD POISONING - therapy

  LEAD POISONING - prevention and control

  CHELATING AGENTS - therapeutic use