NurseSavvy Cheat SheetDisease
Lead Poisoning
Pathophysiology & Risk Factors
Lead has no useful role in the body and no safe level in a child. The usual route is paint: houses built before 1978 may still carry lead paint, and as it deteriorates it becomes chips and household dust that a toddler transfers to their mouth during ordinary play. Children absorb a far larger fraction of ingested lead than adults do, and their developing nervous systems are the tissue most affected. Iron-deficient children absorb more still, which is why nutrition is part of the picture rather than a footnote.
Signs & Symptoms
EarlyProgresses →
no symptoms at all Hallmark
the usual presentation — which is why screening finds it, not assessmentirritability and poor concentration
vague abdominal pain and constipation
loss of appetite
Late / Severe
developmental delay or loss of milestones Hallmark
learning difficulty and behaviour problems
anemia
seizures and altered consciousness
severe poisoning — encephalopathyInterventions & Priorities
Elevated lead level — what happens in order
- Confirm with a venous levela finger-stick screen can be contaminated
- Find and remove the sourcethe step that actually protects the child
- Chelate if the level warrantslowers the circulating lead
- Correct iron and calciumless lead is absorbed
- Track developmentdamage already done needs services
Treatments & Medications
chelation therapy Hallmark
binds lead so it can be excreted; lowers the level but does not undo neurologic damagesuccimer
oral chelatoredetate calcium disodium
parenteral chelator for higher levelsiron supplementation
corrects the deficiency that increases absorptiongenerous fluids during chelation
the kidneys excrete the bound leadPatient Teaching
wet-mop floors and wipe sills rather than sweeping Hallmark
sweeping lifts lead dust into the airwash hands and toys often, especially before eating Hallmark
run the cold tap before using water for formula
serve iron-rich and calcium-rich foods
never sand or dry-scrape old paint with a child in the home
return for every repeat lead level
Report Nowescalate immediately
seizure or altered consciousness Hallmark
lead encephalopathy — a medical emergencypersistent vomiting
loss of previously achieved milestones Hallmark
a level that rises again after chelation Hallmark
the child is still being exposeda sibling in the same home who has never been screened
Clinical Pearl
Chelation lowers the number. Removing the child from the lead is what protects the brain — and nothing reverses the damage already done.