Characteristics of pediatric lead admissions seen by medical toxicology service
Dean DJ, Jacobs E, King AM, Malone E, and Aaron CK. Characteristics of pediatric lead admissions seen by medical toxicology service. Journal of Medical Toxicology 2020; 16(2):124-125.
Journal of Medical Toxicology
Background: Pediatric lead poisoning is a frequent consultation to our toxicology service. In partnership with pediatric hematology, the toxicology service developed a unique protocol that includes admission and chelation for patients with blood lead levels (BLL) > 40 mcg/dL. Chelation is performed with DMSA and IV CaNa2EDTA infusion for 120 hours. Admission removes the child from further exposure and allows the health department to identify and mitigate the source. Further, admission facilitates family education and nutritional counseling, arranges close follow-up with our lead clinic, and provides expeditious access to ancillary services to optimize health outcomes. Methods: This is a retrospective review of pediatric medical toxicology consultations with the diagnosis of lead intoxication, plumbism, and lead exposures. Results: Of the 101 consultations completed between July 2013 and August 10, 2019, there were 77 unique patients with 24 (23.8%) having > 2 hospitalizations and 4 with > 3 hospitalizations. The average LOS was 6 days and average presenting BLL was 41.5 mcg/dL; 38% of patients had radiopaque foreign bodies presumed to be lead and were administered whole bowel irrigation; 74/101 consultations were chelated. There were infrequent minor reported adverse effects and no moderate or major effects of chelation. Discussion: Compliance with less-aggressive and prolonged outpatient succimer protocols can be problematic due to availability of succimer and lack of knowledgeable providers. Further, a large proportion requires acute gut decontamination. This protocol is intensive and comprehensive. A subset of patients had repeat admissions for persistently elevated BLL likely from re-exposure or redistribution. Conclusion: We find that hospitalization at a specialty center, utilizing this protocol, efficiently coordinates medical and governmental social support services: it is safe and comprehensive.