The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research.
This podcast is a collaboration between PECARN STELAR node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC).
Show notes by: Mohsen Saidinejad, MD and Ilene Claudius MD – Harbor UCLA Medical Center
Lead
Main concern is long term effects on intellectual development
Capillary levels are often falsely elevated; confirm with venous if high.
Sources: parents’ jobs or hobbies, foreign spices, folk remedies or leaded pain
Whole blood lead levels are what we are looking for.
- <3.5 mcg/dL is fine
- 5-19 mcg/kg- Repeat, take developmental history, take environmental history and modify sources, possibly fill out form for intervention (state dependent)
- 20-44 mcg/dL- as above plus get x-ray for lead foreign bodies in GI tract, contact Poison Control Center (1-800-222-1222) or Pediatric Environmental Health Unit
- >45 mcg/dL- Start DMSA or succimer
Admit for neurologic symptoms
Mercury
Can be elemental (from thermometers), inorganic (industrial salts, skin whitening products), or organic (fish via industrial sources).
Inorganic
Test: 24h or spot mercury urine collection in specialized container after 48h without seafood
Sx: Red palms and soles + rash
Personality changes
N/V/abdominal pain
Organic
Test: Whole blood level
Sx: Mainly neurological (paresthesia, ataxia, tremor, vision change, dysarthria)
Some GI but less than inorganic
