From the Guidelines
The treatment for lead toxicity primarily involves removing the source of exposure and chelation therapy to eliminate lead from the body, with the most recent and highest quality study recommending chelation therapy for severe cases with blood lead levels above 45 μg/dL or with significant symptoms 1.
Key Recommendations
- For severe cases with blood lead levels above 45 μg/dL or with significant symptoms, chelation therapy is recommended using medications such as succimer (DMSA) at 10 mg/kg orally every 8 hours for 5 days then every 12 hours for 14 days, calcium disodium EDTA at 1000-1500 mg/m²/day IV for 5 days, or dimercaprol (BAL) at 3-5 mg/kg IM every 4 hours for severe cases.
- Supportive care is essential, including nutrition rich in calcium and iron which can reduce lead absorption.
- For children with levels between 20-45 μg/dL, environmental intervention and close monitoring may be sufficient.
- Follow-up testing is crucial to ensure lead levels are decreasing.
Rationale
The American Academy of Pediatrics (AAP) recommends a blood lead concentration of ≥5 μg/dL (≥50 ppb) for case management, with the goal of reducing lead exposure and preventing long-term health effects 1.
Additional Considerations
- Patients should also receive nutritional support and neurological monitoring during and after treatment.
- Long-term neurological damage from lead exposure may not be completely reversible, so prevention and early intervention are vital.
- The Centers for Disease Control and Prevention (CDC) recommends that children with elevated blood lead concentrations be monitored until environmental investigations and remediation are complete and blood lead concentrations decline 1.
From the Research
Treatment for Lead Toxicity
The treatment for lead toxicity typically involves the use of chelating agents, which are medications that bind to lead and help remove it from the body. Some of the commonly used chelating agents for lead toxicity include:
Chelating Agents
These chelating agents work by binding to lead in the body and helping to remove it through the urine. The choice of chelating agent depends on the severity of the lead poisoning and the patient's overall health.
- Edetate calcium disodium is typically given intravenously and is often used in severe cases of lead poisoning 2, 3
- Dimercaptosuccinic acid is given orally and is often used in less severe cases of lead poisoning 4, 5
Effectiveness of Chelating Agents
Studies have shown that both edetate calcium disodium and dimercaptosuccinic acid are effective in reducing blood lead levels and improving symptoms of lead poisoning 2, 4, 3, 5
- A study comparing the two chelating agents found that dimercaptosuccinic acid had a greater impact on reducing blood lead concentrations, while edetate calcium disodium had a greater impact on lead mobilization 2
- Another study found that dimercaptosuccinic acid was effective in increasing urine lead excretion and reducing blood lead concentrations in adult patients with inorganic lead poisoning 5
Important Considerations
It's worth noting that lead poisoning can have serious health consequences, especially in children, and prompt treatment is essential to prevent long-term damage 6
- The Centers for Disease Control and Prevention (CDC) recommends that children under the age of 6 be screened for lead poisoning as part of routine health check-ups 6