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Management guidelines for children with Elevated Blood Lead Levels
(BLL)
| <10 µg/dL |
- Evaluate nutrition and risk of lead exposure
- Provide anticipatory guidance to caregiver on: lead
poisoning, test results, lead hazards and prevention (e.g.
nutrition, housekeeping, hand washing, controlling hand-to-mouth
behavior, avoiding take-home lead)
|
| 10-14 µg/dL |
- History and physical
- Evaluate nutrition and lead exposure history
- Provide guidance to caregiver on: lead poisoning, test
results, lead hazards and prevention (e.g. nutrition,
housekeeping, hand washing, hand-to-mouth behavior, take-home
lead and importance of retesting)
|
| 15-19 µg/dL |
- History and physical
- Evaluate nutrition and lead exposure history
- Provide guidance to caregiver on: lead poisoning, test
results, lead hazards and prevention (e.g. nutrition,
housekeeping, hand washing, hand-to-mouth behavior, take-home
lead and importance of retesting)
- Consider hct, hgb, and WIC referral
- If follow-up venous BLL = 15 µg/dL, treat as for
20-44 µg/dL, below
|
| 20-44 µg/dL |
- History and physical
- Evaluate nutrition, psychosocial and neurodevelopmental
status, and lead exposure history
- Provide guidance to caregiver on: lead poisoning, test
results, lead hazards, and prevention: (e.g. nutrition,
housekeeping, hand washing, hand-to-mouth behavior, take-home
lead, and importance of retesting· Hct, hgb, and
WIC referral· Consider FEP, ferritin, Fe/TIBC,
and abdominal x-rays
- Refer to local health department or CLPPP for case management
and environmental investigation
- Refer to CCS for eligibility determination and medical
specialty services
- Refer family members (especially if pregnant) for evaluation
and testing; test young children in family
|
| 45-69 µg/dL |
- As above for 20-44 plus refer to local health department
or CLPPP and CCS immediately
- Probably chelate, per protocol: CaNa²EDTA in hospital
or succimer as outpatient; repeat as needed, based on
blood lead rebound.
- Consider hospitalization to prevent further exposure,
implement treatment, and monitor response.
|
| ≥70 µg/dL |
- As above for 20-44 µg/dL plus refer to local health
department or CLPPP and CCS immediately
- Chelate per protocol: combined therapy with BAL and
CaNa²EDTA; repeat as needed, based on blood lead
rebound
- Immediate hospitalization to prevent further exposure,
implement treatment, and monitor response
|
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