From the Guidelines
For a child with a blood lead level of 24 μg/dL in a house built in 1928, the most appropriate course of action is to report the case to local health authorities, as it exceeds the CDC reference value of 5 μg/dL, and initiate environmental investigation and remediation. This approach is based on the guidelines provided by the American Academy of Pediatrics, as outlined in the study published in Pediatrics in 2016 1. The management of a child with a blood lead level of 24 μg/dL focuses on environmental intervention, removing the child from lead exposure, nutritional counseling, and close monitoring with follow-up testing.
Key Considerations:
- The age of the house (1928) strongly suggests lead-based paint as the exposure source, as lead paint was commonly used in homes built before 1978.
- Reporting the case initiates a public health response, including environmental investigation to identify and remove lead sources.
- Neither DMSA (dimercaptosuccinic acid) nor EDTA (ethylenediaminetetraacetic acid) chelation therapy is indicated at this blood lead level, as chelation is typically reserved for levels ≥45 μg/dL or in symptomatic patients.
- Nutritional counseling should ensure adequate iron, calcium, and vitamin C intake, and close monitoring with follow-up testing is necessary to assess the effectiveness of the interventions.
Recommendations:
- Report the case to local health authorities to initiate environmental investigation and remediation.
- Remove the child from lead exposure.
- Provide nutritional counseling to ensure adequate iron, calcium, and vitamin C intake.
- Conduct close monitoring with follow-up testing to assess the effectiveness of the interventions, as recommended by the study published in Pediatrics in 2016 1.
From the FDA Drug Label
Each vial contains a sterile, pyrogen-free freeze-dried mixture of 1.0 mg dimercaptosuccinic acid, 0.42 mg stannous chloride dihydrate [0.38 mg (minimum) stannous chloride dihydrate (SnCl2•2H2O) and 0.46 mg (maximum) total tin expressed as stannous chloride dihydrate (SnCl2•2H2O)], 0.70 mg ascorbic acid, and 50. 0 mg inositol. Chemical Name: meso-2,3-dimercaptosuccinic acid The succimer component of DMSA consists of more than 90% meso isomer and less than 10% d,l isomer.
The appropriate treatment for a child with elevated blood lead levels (24 μg/dL) is chelation therapy.
- Dimercaptosuccinic acid (DMSA), also known as succimer, is a chelating agent that can be used to treat lead poisoning 2.
- Ethylenediaminetetraacetic acid (EDTA) is also a chelating agent, but the provided label does not specify its use for lead poisoning 3.
- Given the child's elevated blood lead level and the age of the house, reporting the case is also necessary to ensure environmental investigation and remediation. It is essential to consult a healthcare professional to determine the best course of treatment.
From the Research
Treatment Options for Elevated Blood Lead Levels
- The child's blood lead level is 24 μg/dL, which is below the threshold of 25 μg/dL for classic symptoms of lead toxicity in children 4.
- However, the Centers for Disease Control and Prevention (CDC) recommends further evaluation for children with blood lead concentrations above 10 μg/dL 4.
- Chelation therapy may be considered for children with blood lead concentrations above 45 μg/dL, but its use for lower levels remains controversial 4, 5.
Chelation Agents
- Dimercaptosuccinic acid (DMSA) is an oral chelating agent used to treat lead and heavy-metal poisoning, with encouraging results for mercury and arsenic poisoning as well 6.
- Ethylenediaminetetraacetic acid (EDTA) is another chelating agent, but its use may result in potentially harmful shifts in the body lead burden 5.
- DMSA has been shown to be effective in reducing elevated lead levels, with a lower risk of adverse effects compared to EDTA 7, 8.
Reporting the Case
- Given the child's blood lead level and the age of the house, it is likely that the lead exposure is due to lead-based paint or contaminated soil 4.
- Reporting the case to the relevant authorities may be necessary to ensure that the child receives proper treatment and to prevent further lead exposure 4.