CC May 2016 Lead Poisoning

echoecho's version from 2016-07-17 18:32


Question Answer
Lead is toxic to humans, particularly in what age group?young children
For years the CDC defined elevated blood levels as what?> 10 mcg/dL
However in recent years, levels < 10 mcg/dL can also cause what?1) cognitive dysfunction (inattention and decreased academic achievement) 2) cardiovascular 3) immunological 4) endocrine effects
Currently, a GLL (blood lead level) is considered elevated if it is what level?> 5 mcg/dL
With primary prevention efforts to remove lead from paint and gasoline, the number of children with elevated BLLs have decreased, however, ____% of children 1-5 years of age still have BLL of > 5 mcg/dL2.5
The prevalence of elevated BLLs is seen in what situations?1) urban populations 2) older housing built before 1970 3) low-income children 4) refugee children 5) those entering foster care
In some studied communities, the BLLs was a high as ____%?16
Overall, in the US, the % of elevated BLLs (>10 mcg/dL) has decreased from ____% in 1997 to ____% (approx 250,000 children) in 2014?7.61; 0.58
With the new lower criterion for elevated BLL, the % of affected children are actually _____ (higher vs. lower)?higher (an additional 200,000 children)
Children between ____ and ____ months of age are particularly sensitive to the adverse effects of lead? Why9; 36; because at this age, the blood-brain barrier is LESS mature and more easily allows the passage of lead into the developing nervous system and children in this age group are MORE likely to be iron deficient
What is the association of lead intoxication and iron deficiency?there is increased GI absorption of lead in the presence of iron deficiency
Why are children more likely to be exposed to lead dust?1) spend more time on the ground 2) engage in hand-to-mouth behavior
List sources of lead exposure?1) lead paint 2) lead-soldered pipes 3) lead-glazed ceramics 4) lead-soldered cans from other countries 5) lead-coated electrical wire 6) lead crystal 7)automobile emissions 8) lead-using industries 9) some herbal and folk medications (Ayurevedic medicine from Tibet, Azarcon, Greta) 10) miscellaneous imported products (candy, cosmetics, mini blinds and toys)
Is universal screening of all children currently recommended?no
What does the USPSTF and AAFP state regarding routine screening?insufficient evidence for OR against routine screening in asymptomatic children ages 1-5 years who are at increased risk by questionnaire
*** USPSTF and AAFP recommend what regarding screening in asymptomatic children ages 1-5 who are at average risk??AGAINST screening
The federal "State Medicaide Manual" mandates lead testing of all Medicaid-eligible children at ages ____ and ___ years, and also for children ___ to ___ months who have not been previously screened?1; 2; 36; 72
In contrast to these regulations, and in recognition of the decreased prevalence of elevated BLL in at risk populations, the CDC recommends what?that states develop local risk-based approaches in screening
The use of the above criteria for non-Medicaid eligible children would also be reasonable, true or false?true
Screening should be done for any Medicaid-eligible child who meets any of what criteria?1) a parent or a healt-care provider suspects the child to be at risk for lead exposure 2) child has a sibling or frequent playmate with elevated BL 3) child is a recent immigrant, refugee or foreign adoptee 4) child's parent or principal caregive works professionally or recreationally with lead 5) child has a houshold member who uses traditional folk or ethnic remedies or cosmetics or who routinely eats food imported informally (by a family member) from abroad 6) child's family has been designated at increased risk for lead exposure by the health dept because the family has local risk fxs for lead exposure (residence in a designated high-risk zip code or near a known point source)
Type of sampling preferred method of screening? What other method can also be used?1) venous sampling 2) capillary (fingerstick)
*** What should be done if elevated capillary BLL is seen?retesting with a venous sampling
In 2012, the CDC released recommendations for scheduling of confirmatory venous testing as well as follow-up BLL testing. List these?1) Time to confirmatory testing = 5-9 mcg/dL (1-3 months); 10-55 mcg/dL (1 wk to 1 month - higher levels warrant earlier testing); 45-59 mcg/dL (48 hours); 60-69 mcg/dL (24 hours); > 70 (urgently as emergency test) 2) schedule for surveillance blood lead testing = venous BLL of 5-9 mcg/dL (early f/u testing of 2-4 tests after ID = 3 months; later f/u testing after levels are declining = 6 months); 10-19 mcg/dL (early f/u testing 2-4 tests after ID = 1-3 months; later f/u testing after levels are declining = 3-6 months); 20-24 mcg/dL (early f/u testing 2-4 tests after ID = 1-3 months; later f/u testing after levels are declining = 1-3 months); 25-44 mcg/dL (early f/u testing 2-4 tests after ID = 2 weeks to 1 month; later follow-up tetsing (after levels are declining) = 1 month); > 45 mcg/dL (early f/u testing 2-4 tests after ID = ASAP; later f/u testing (after levels are declining) = ASAP)
Seasonal variation of BLL exists and is more apparent in what climates. Grater exposure in the ______ months may necessitate more frequent follow-ups?cold; summer
Providers should check with what department in their states as states may have their own recommendations and guidelines?health department
An aggressive search for potential lead sources is critical for children with elevated BLL. What, in addition, should be done next?1) detailed hx 2) environmental assessment 3) lab testing (hgb, iron) 4) abdominal x-ray if lead ingestion is suspected
*** Correction of what deficiency is proven to reduce BLL?iron deficiency
List the main toxic effects of lead?1) neurodevelopmental abnormalities 2) lower IQ scores 3) attention difficulties 4) behavior problems (aggressive, antisocial, delinquient behavior) 5) poor eye-hand coordination 6) abnormal posture and balance 7) sleep disturbances 8) longer reaction times
List other neurological deficiates associated with elevated BLL?1) hearing loss 2) peripheral neuropathy 3) encephalopathy (altered level of consciousness, ataxia, seizures, coma)
List adverse effects of elevated BLL?1) anemia (high-level, acute poisoning associated with hemolytic anemia) 2) nephropathy (impairing proximal tubular fuction) 3) lead colic (vomiting, abdominal pain, constipation) 4) endocrine impairment (decreased vit D metabolism, delayed puberty, decreased height)
Is there any direct hepatic toxicity of elevated BLLs?no
What is the initial intervention for any child found to have elevated BLLs?1) education of parents and caregivers 2) aggressive environmental intervention (removal of sources)
What therapy is indicated for all children with BLL > 45 mcg/dL?chelation
Why is treating children with BLL levels 25-44 mcg/dL controversial?it may reduce BLL but does NOT improve neurodevelopment or other clinical outcomes
List the chelation agents?1) Dimercaprol (BAL = British antilewisite) in oil (IM) - used primarily for severe toxicity (BLL > 70 mcg/dL) 2) Edetate disodium calcium (CaNa2EDTA = calcium disodium salt of ethylenediaminetetraacetic acid (EDTA) IV - used for moderate and severe toxicity 3) succimer (Chemet), or DMSA (2,3-dimercaptosuccinic acid) (oral) - used for mild and moderate toxicity
List the facts that need to be taken into consideration to determine the choice of agent and whether a child needs to be hospitalized?1) level of lead toxicity 2) age of child 3) likelihood of compliance with oral therapy 4) ability to remove child to a lead-free environment
*** SUMMARY = Currently a blood level is considered elevated if it is > ___ mcg/dL?5
*** SUMMARY = Children between ____ and ____ months of age are particularly sensitive to the adverse effects of lead?9; 36
*** SUMMARY = Is universal screening of all children recommended?no
*** SUMMARY = The federal "Sate Medicaid Manual" mandates lead testing of all Medicaid-eligible children at ages ___ and _____ years, and also for children _____ to _____ months who have not been previously screened?1; 2; 36; 72
*** SUMMARY = What type of sampling is the preferred method of screening, although properly obtained _____ samples can be very accurate?venous; capillary (fingerstick)
*** SUMMARY = Elevated capillary levels should be confirmed with a ____ sample?venous