Version May 2024
| Symptomatic or asymptomatic with blood lead level ≥70 mcg/dL (3.38 micromol/L) | |
| (a) | The children should be hospitalized immediately. |
| (b) | Report the case as well as any other children at possible risk of lead poisoning to appropriate health authorities. |
| (c) | Perform history, physical examination and baseline studies (abdominal radiograph, CBC with differential, blood lead level, erythrocyte protoporphyrin, serum electrolytes, BUN, creatinine, serum calcium, AST, ALT, urinalysis, and, in patients with encephalopathy, computed tomography of the head). |
| (d) | In consultation with an expert in the management of pediatric lead poisoning, administer BAL to symptomatic patients. Asymptomatic patients may receive succimer.¶ |
| (e) | In symptomatic patients, after BAL is started, and once urine output is established, begin CaNa2EDTA intravenously. In asymptomatic patients, begin CaNa2EDTA intravenously 48 hours after succimer is started.¶ |
| (f) | During chelation, monitor serum electrolytes, calcium, BUN, creatinine, complete blood count, AST, ALT and urinalysis daily; measure blood lead level on day 3 and, if applicable, day 5. |
| (g) | Wait two days after completion, recheck lead levels, and administer a second course if Pb levels >45 mcg/dL (2.17 micromol/L). A third course may be necessary if lead levels remain elevated >45 mcg/dL (2.17 micromol/L) 5-7 days after the second course. |
| (h) | Succimer alone may be used for the second or third course of chelation in patients who are asymptomatic and whose lead levels are between 45 (2.17 micromol/L) and 70 mcg/dL (3.38 micromol/L) if they are cooperative, lead-safe housing is assured, and good compliance is anticipated.¶ |
| (i) | Provide parents with educational and nutritional counseling. |
| (j) | Do not discharge until environmental investigation is completed and recommendations on care at home are made. Patients must be discharged to a lead-safe environment. |
| (k) | Ensure monitoring of lead levels after discharge by a clinician with expertise in pediatric lead poisoning. |
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