Supplemental Reading

Ellenhorn MJ. Ellenhorn's Medical Toxicology:

Diagnosis and Treatment of Human Poisoning (2nd ed.). Baltimore: Williams & Wilkins, 1997.

Gosselin RE, Smith RP, and Hodge HC. Clinical Toxicology of Commercial Products (5th ed.). Baltimore: Williams & Wilkins, 1984.

Haddad LM, Shannon MW, and Winchester JF. Clinical Management of Poisoning and Drug Overdose (3rd ed.). Philadelphia: Saunders, 1998.

Hayes AW (ed.). Principles and Methods of Toxicology (4th ed.). Philadelphia: Taylor & Francis, 2001.

Klaassen CD (ed.). Casarett and Doull's Toxicology, the Basic Science of Poisons (óth ed.). New York: McGraw Professional, 2001.

Rom WM (ed.). Environmental and Occupational Medicine (3rd ed.). Philadelphia: Lippincott-Raven, 1998.

Sullivan JB, Jr. and Krieger GR (eds.). Hazardous Materials Toxicology: Clinical Principles of Environmental Health. Baltimore: Williams & Wilkins, 1992.

^ Case Study A Case of Poisoning

A 5-year-old girl is taken to the doctor's office by her mother following a conference with her kindergarten teacher. The teacher is concerned because compared to her kindergarten classmates, she is hyperactive, restless, and easily distracted. Recent testing revealed that the child's vision was normal but hearing acuity was below normal. Recently the child has complained of abdominal pain and has had occasional constipation. About 3 years ago the parents moved into a 75-year-old house in the inner city and have been renovating it extensively. Within the past year, the parents separated and the father moved out of the house.

1. What is the most likely cause of the child's problems?

2. What tests should be run to help in the diagnosis?

3. What is the best treatment option?

Answers:

1. These symptoms are consistent with childhood lead poisoning. The paint used originally in older homes usually contains lead. Since the parents have been renovating this older home, it is likely that they have removed some of the older paint, generating lead-containing dust and paint chips. Small children may exhibit pica, which is the compulsive eating of nonfood items, and this can occur during times of stress, such as the separation of parents. If the parents have not cleaned up adequately after removing the paint, it is probable that the child has had the opportunity to consume substantial quantities of lead.

2. Measuring the child's blood lead level will be very useful in assessing the possibility of lead poisoning. There is evidence that at blood lead levels of about 10 ^g/dL, children are at risk for developmental impairment. Other tests that may be useful include examination for microcytic anemia and erythrocyte stippling and radiographic examination of the long bones for lead lines.

3. Several chelators can effectively lower the child's blood lead level. These include dimercaprol, ede-tate calcium disodium (CaNa2EDTA) and suc-cimer. Protocols are available for using the chela-tors depending upon the severity of symptoms.

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