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Trends in the management of childhood lead poisonings
1Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467.
Insights
Prompt intervention for childhood lead poisoning significantly reduces blood lead levels but does not dramatically decrease bone lead. Further research is needed to compare treatments like CaNa2EDTA and DMSA.
Area of Science:
- Environmental Health
- Toxicology
- Pediatrics
Background:
- The long-term benefits of early intervention for childhood lead poisoning, beyond preventing symptomatic disease, remain unclear.
- It is uncertain if children with blood lead levels of 25-54 µg/dL experience irreversible damage before identification.
Purpose of the Study:
- To investigate the substantive beneficial effects of prompt medical management and environmental intervention in children with lead toxicity.
- To evaluate the impact of CaNa2EDTA chelation therapy on bone lead levels.
Main Methods:
- A prospective treatment outcome study involving 162 children with lead exposure.
- Utilized CaNa2EDTA (calcium disodium ethylenediaminetetraacetic acid) chelation therapy when indicated.
- Measured bone lead levels using L-line x-ray fluorescence.
Main Results:
- Environmental and medical management led to significant reductions in blood lead levels, erythrocyte protoporphyrin, and lead diuresis.
- CaNa2EDTA treatment did not substantially decrease bone lead values six months post-enrollment in any patient group.
- L-line x-ray fluorescence allows for the assessment of lead exposure over months to years, unlike blood lead levels.
Conclusions:
- While prompt intervention effectively lowers blood lead, its impact on bone lead requires further investigation.
- Systematic assessment and randomized controlled studies are necessary to compare the efficacy of DMSA and CaNa2EDTA for childhood lead poisoning treatment.
Abstract:
It is unknown whether prompt medical management (with or without chelation therapy) and environmental intervention have beneficial effects other than stopping the progression towards symptomatic childhood lead poisoning. Stated differently, does prompt intervention have substantive beneficial effects or are untreated lead toxic children with blood lead values between 25-54 micrograms/dl irrevocably damaged by the time of their identification. We are carrying out a prospective treatment outcome study with CaNa2EDTA (when indicated) at our Center to hopefully answer this critical question, within the context of a multidisciplinary study. The results in 162 children indicate that environmental and medical management produce significant reductions in blood lead, erythrocyte protoporphyrin and the lead diuresis during a CaNa2EDTA provocative test. However, CaNa2EDTA treatment failed to decrease bone lead values dramatically, measured by L-line x-ray fluorescence, six months after enrollment in any patient group (treated or untreated with CaNa2EDTA). The uses of L-line x-ray fluorescence in this study and K-line x-ray fluorescence measurements of lead in bone in other reported studies open a wide time window of months to years of lead exposure, compared to 30-45 days, the time of exposure captured by blood lead levels. As with all chelating agents, DMSA should be administered to children in lead free housing, after this drug's toxicity is more widely assessed. The potential capability of DMSA to ameliorate neurobehavioral deficits produced by lead must be systematically assessed and compared with CaNa2EDTA in a randomized, controlled study before the use (s) of either drug become uncritically accepted as the treatment of choice for childhood lead poisoning, in addition to full abatement.