From the Guidelines
Treatment of lead poisoning primarily involves removing the source of exposure, followed by chelation therapy for moderate to severe cases, with the specific approach depending on the blood lead level, as outlined in the AAP guidelines 1.
Key Considerations
- For children with blood lead levels above 45 μg/dL, chelation therapy is recommended, with options including succimer (DMSA), calcium disodium EDTA, and dimercaprol (BAL) 1.
- The choice of chelating agent and dosage depends on the severity of the lead poisoning and the patient's overall health, with typical dosages including:
- Succimer (DMSA) at 10 mg/kg every 8 hours for 5 days, then every 12 hours for 14 days
- Calcium disodium EDTA at 1000-1500 mg/m²/day divided over 5 days
- Dimercaprol (BAL) at 3-5 mg/kg every 4 hours for severe cases
- Supportive care includes maintaining hydration, monitoring renal function, and addressing nutritional deficiencies, particularly iron, calcium, and zinc, which can reduce lead absorption 1.
Blood Lead Level Guidelines
- For blood lead levels <5 μg/dL, review laboratory results with the family, repeat the blood lead concentration in 6-12 months if the child is at high risk for lead exposure, and provide anticipatory guidance on common sources of environmental lead exposure 1.
- For blood lead levels 5-14 μg/dL, perform steps as described above, retest venous blood lead concentration within 1-3 months, and provide nutritional counseling related to calcium and iron 1.
- For blood lead levels 15-44 μg/dL, confirm the blood lead concentration with repeat venous sample within 1-4 weeks, consider abdominal radiography, and provide treatment in consultation with an expert 1.
- For blood lead levels >44 μg/dL, confirm the blood lead concentration with repeat venous lead level within 48 hours, consider hospitalization or chelation therapy, and contact local pediatric environmental health specialty unit or Poison Control Center for guidance 1.
From the FDA Drug Label
When a source for the lead intoxication has been identified, the patient should be removed from the source, if possible The recommended dose of edetate calcium disodium for asymptomatic adults and pediatric patients whose blood lead level is < 70 mcg/dl but > 20 mcg/dl ... is 1000 mg/m2/day When the blood lead level is > 70 mcg/dl or clinical symptoms consistent with lead poisoning are present, it is recommended that edetate calcium disodium be used in conjunction with BAL (dimercaprol)
- Treatment for lead poisoning involves:
- Removing the patient from the source of lead intoxication, if possible
- Administering edetate calcium disodium at a dose of 1000 mg/m2/day for asymptomatic patients with blood lead levels < 70 mcg/dl but > 20 mcg/dl
- Using edetate calcium disodium in conjunction with BAL (dimercaprol) for patients with blood lead levels > 70 mcg/dl or clinical symptoms consistent with lead poisoning
- Continuing therapy for 5 days, then interrupting for 2-4 days to allow redistribution of lead and prevent depletion of essential metals 2
From the Research
Treatment Options for Lead Poisoning
The treatment for lead poisoning (plumbism) 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 include:
- Edetate calcium disodium (CaNa2EDTA) 3
- Dimercaptosuccinic acid (DMSA) 3, 4, 5
- Succimer, an oral lead chelator 4, 5
Chelation Therapy
Chelation therapy is recommended for individuals with blood lead levels of 45 μg/dL or higher 6. For blood levels between 20 and 45 μg/dL, treatment is indicated if the individual is symptomatic 6. The goal of chelation therapy is to reduce the amount of lead in the body and prevent further damage.
Treatment Regimens
Different treatment regimens have been studied, including:
- Oral DMSA (1050 mg/m2/day) for two five-day courses separated by a 10-day rest period 3
- Intravenous CaNa2EDTA (500 mg/m2/day) for two five-day courses separated by a 10-day rest period 3
- Oral succimer (10 mg/kg or 350 mg/sq m every eight hours for five days, followed by 10 mg/kg or 350 mg/sq m every 12 hours for an additional two weeks) 4
Important Considerations
It is essential to note that the treatment of lead poisoning should always involve the removal of the source of lead exposure 6, 7. Additionally, individuals with lead poisoning may require long-term follow-up and counseling to monitor for any potential neurodevelopmental effects 6.