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.