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Elevated Venous Blood Lead Levels — Medical Management — Clinical Pathway: Primary Care

Elevated Venous Blood Lead Levels — Primary Care

Medical Management

Review Sources of Lead Exposure

Assess immediate risks for ongoing exposure, CDC site  

Evaluate Risk Action
Home
  • Age of home
  • Chipped or peeling paint
  • Recent or current remodeling
  • Family shares home with a person currently being monitored/treated for lead exposure
  • VBLL ≥ 3.5 μg/dL
  • Lead testing of home
  • Initiate remediation if lead found in the home
  • Consult Social Work for housing needs
Caregivers
  • Job or hobbies involving:
    • Manufacturing
    • Construction
    • Painting
    • Metalwork
    • Regular use of firearms
Household Members
  • All children ≤ 6 yrs
  • Individuals exhibiting pica
  • Children ≤ 16 yrs old born outside of USA
  • Pregnant
Other
  • Products from another country
    • Traditional medicines
    • Foods, spices
    • Toys
    • Cosmetics

Iron Supplementation and Nutrition Counseling

  • Obtain CBC, ferritin
    • Hgb normal, supplement with children’s multivitamin with iron
    • Treat iron deficiency as below
  • Emphasize iron and calcium-rich foods
  • Nutrition consult as indicated

Oral Iron

Dosing and Duration Tips and Recommendations
  • Dose
  • 3-6 mg/kg/d elemental Fe
  • Max 100 mg/d
  • Duration
  • 4-6 mos
  • Re-evaluate according to therapeutic goals
  • Available Formulations
    • Immediate-release, e.g., ferrous sulfate
      • May have higher absorption
      • May be associated with more GI adverse effects, e.g., constipation
  • Slow-release or enteric-coated products
    e.g., polysaccharide iron complex
    • May have lower absorption
    • Less GI adverse effects
    • Once daily dosing
  • To optimize absorption of oral iron
    • Take in the morning
    • Consider vitamin C, 25 mg once a day
  • Concomitant fibers, calcium intake may decrease absorption.
  • Constipation concern, consider use of a laxative:
    • Polyethylene Glycol (PEG) 3350
      • < 20 k
      • 8.5 g, 1/2 capful of powder in 4 oz of liquid
      • ≥ 20 kg, Adults
      • 17 g, 1 capful of powder in 8 oz of liquid
    • Docusate
      • < 6 yrs
      • 20 mg daily
      • > 6 yrs
      • 100 mg daily

 

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