Summary of Recommendations for Children With Confirmed (Venous) Elevated Blood Lead Concentrations16
| Blood Lead Concentration | Recommendations |
|---|---|
| 10–14 μg/dL | Lead education |
| Dietary | |
| Environmental | |
| Follow-up blood lead monitoring | |
| 15–19 μg/dL | Lead education |
| Dietary | |
| Environmental | |
| Follow-up blood lead monitoring | |
| Proceed according to actions for 20–44 μg/dL if | |
| A follow-up blood lead concentration is in this range at least 3 months after initial venous test; or | |
| Blood lead concentration increases | |
| 20–44 μg/dL | Lead education |
| Dietary | |
| Environmental | |
| Follow-up blood lead monitoring | |
| Complete history and physical examination | |
| Lab work | |
| Hemoglobin or hematocrit | |
| Iron status | |
| Environmental investigation | |
| Lead hazard reduction | |
| Neurodevelopmental monitoring | |
| Abdominal radiography (if particulate lead ingestion is suspected) with bowel decontamination if indicated | |
| 45–69 μg/dL | Lead education |
| Dietary | |
| Environmental | |
| Follow-up blood lead monitoring | |
| Complete history and physical examination | |
| Lab work | |
| Hemoglobin or hematocrit | |
| Iron status | |
| Free EP or ZPP | |
| Environmental investigation | |
| Lead hazard reduction | |
| Neurodevelopmental monitoring | |
| Abdominal radiography with bowel decontamination if indicated | |
| Chelation therapy | |
| ≥70 μg/dL | Hospitalize and commence chelation therapy |
| Proceed according to actions for 45–69 μg/dL |
| Not Recommended at Any Blood Lead Concentration |
|---|
| Searching for gingival lead lines |
| Evaluation of renal function (except during chelation with EDTA) |
| Testing of hair, teeth, or fingernails for lead |
| Radiographic imaging of long bones |
| X-ray fluorescence of long bones |
ZPP indicates zinc protoporphyrin.