F. Screening Tests
--Hearing Screening in Children
--Vision Screening in Children
--Glossary of Ophthalmologic Terms
--FEP in the Diagnosis of Iron Deficiency and Iron Deficiency Anemia

Lead Poisoning: When, How and At What Ages to Screen

Who Should be Screened for Lead and at What Ages: Controversial. AP statement in June 98 states that screen only if >12% of 1-2 year olds have elevated levels (>10 ug/dl) or if greater than 27% of housing in city built before 1950. Usual times of screening: 6-12 months, 2 years, 4 years

Questionnaires are used in many places, but some question of their effectiveness: Higher risk if:

live in or spend a lot of time in a house built before 1950
a house built before 1978 with recent renovation
a family member with increased lead level
an adult member who is exposed to high lead levels at work
live near industry likely to release lead

Methods of Testing for Lead: If done properly, finger stick is reliable, but not always done properly; therefore all abnormal levels need to be confirmed by venous samples. Available are a handheld machine laboratory (ESA machine- $1800) or free standing instrument (ESA -$10000); another option: send to a state lab for atomic absorption test. Also can deal with a company called Leadtech (1-800-low-lead) which will send you a filter paper kit.

Sources of Lead: water, gasoline, paint chips, paint dust, soil, food, air, leadshot.

Symptoms of Lead Poisoning are usually silent but can be associated with the following:

PICA, abdominal pain, encephalopathy, mental retardation, anorexia, hyperirritable, vomiting, ataxia, coma, behavioral changes, ADHD. The biggest concern is that lead toxicity can produce all of these nonspecific symptoms, and the only way to diagnose it is to get a blood lead level. Lead poisoning is also often associated with iron deficiency.

Results of Testing at MCG in Year 1997: of 962 children tested, 83 were elevated on initial fingerstick; only 57 were brought back for venipuncture - 35 of them were elevated for a total of 3.6% of our population. Only 1 was over 45 ug/dl and required treatment with medication.

We have a nurse practitioner that will follow this prospectively. If levels are not greater, we will make changes in how often we screen for lead.

What Levels Do You Treat for Elevated Lead? CDC and AAP Recommendations

Level (ug/dl)	Rx
10-14	Check tests every 3-4 months; retest yearly if returns to normal
15-20	Repeat within 2 months
20-45	Recheck levels at proscribed intervals; have health department check house for lead in environment; medications probably over 30. Repeat levels in 1 month after intervention.
> 45	Single drug chelation therapy if less than 70. Over 70: 2 drugs from choice: po Succimer (DMSA); 2^nd drug: Edetate (CaNa₂ EDTA). Others than could be used: BAL or D-Pen (Penicillamine)

Department of Pediatrics | Medical College of Georgia
Please email comments, suggestions or questions to:
John T. Benjamin M.D., jbenj@mcg.edu

February 27, 2004

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