Let’s switch gears to
another type of poisoning.
The picture of the city you can see
here, this is Flint, Michigan.
And last year, in 2016,
there was a maneuver where a mayor wished to
save money on the water bill for the city
and accepted another source of water.
The government failed to treat
that water appropriately
and it caused lead to leach out of pipes
that existed in the old city system
and they provided lead into the
drinking water for the entire city.
This poisoned thousands of children
and the government was very slow to
respond and knew about the problem
and kept telling people that it
was safe to drink the water,
children in this city.
Children especially because children tend
to be more severely affected than adults
by lead poisoning because
they have developing brains.
So lead poisoning can happen as a
result of a system-wide abuse of water
or some kind of systemic pollution.
But it can also happen in
the home of an older home
where they may be a
history of lead paint
and that paint is now peeling
and the child can eat it.
Or it can be from other
exposure such as
having lead on the parent’s clothes
if they work in certain places.
So children under six
are more susceptible to
brain damage as a result
of lead poisoning.
And this can cause chronic
or acute toxicity.
Let’s go through lead poisoning.
It’s often inhaled as dust
or it’s old paint in old
houses that children peel off
because it’s interesting to
peel off and maybe chew.
They can ingest these paint chips
or if they have psychiatric disturbances,
they may have pica and
just want to eat things.
You can also find it in contaminated
soil or water like in Flint, Michigan.
And typically, the presentation is worse
in children who have a low calcium
or a low iron diet because iron and
calcium compete for lead absorption.
So a high calcium or a high iron diet
is protective against lead poisoning.
The symptoms are important to remember.
A common one with a relatively
low exposure is anemia.
This is usually a microcytic or
sometimes normocytic anemia.
Patients with acute ingestion may
first develop abdominal pain.
If it’s very severe exposure
and the lead levels are high,
they may develop peripheral neuropathy,
they may incur developmental delay,
and they may have
The developmental delay is key.
No amount of lead in the
environment is safe for children.
Children need to be lead-free.
They’ve even shown that lead
levels as low as 5 to 10
may cause, if exposed chronically,
developmental issues with
resulting loss of IQ.
There may be some things
on exam or on testing
that can yield evidence
of lead poisoning.
For instance, we sometimes see children
who get an X-ray for a broken bone
and we see lines on those bones.
That’s a sign of lead toxicity.
They develop these lead lines at
the time of accrual of the lead.
It can adhere to the growing surface
of the bone and create lines.
We see it on CBC.
When we see a microcytic or a normocytic
anemia, more commonly microcytic,
and you may even see basophilic stippling,
which you can see with these arrows,
these little blue dots.
If we suspect lead poisoning, we
need to check a serum lead level.
And always provide iron
supplementation to poisoned children
because that can help compete
with lead ingestion.
It’s important for patients
who have lead exposure
to have long term followup
for developmental problems
and early intervention and other ways
we can do to maximize their potential.
But we generally will treat children
based on what their lead level is.
So if their lead level is 5 to
14, we will remove exposures
and retest them in three months and
watch for associated learning defects.
For lead levels that are 15 to 44,
we will need to confirm
with a venous sample,
because normally, we usually
just get capillary test.
And we get an abdominal
X-ray if they have pica for
fear that there may be lead
chips in their bellies.
So we ask about paint
because that’s so common
and if there is
paint in the house,
we’ll get an abdominal X-ray to
look for other lead in the abdomen.
If that’s present, we may give NG GoLYTELY
to flush it out so that
they don’t absorb it.
Charcoal doesn’t really work.
Next, if they’re 45 to 69,
they’re usually asymptomatic
but we’re going to treat
with oral succimer.
We’re going to chelate them with an oral
agent to try and suck the lead out.
We have to continue to watch
them carefully because
the oral succimer will transiently
raise their lead levels
as some of that lead was
stored in their bones
and is getting sucked
to their plasma.
For patients with a lead level over 70,
these patients will require
They often have encephalopathy
and we have to give both
succimer and calcium EDTA
as ways of controlling
their lead toxicity.
So that’s my review of common
poisonings in children.
Thanks for your time.