In general, the most important measure is to remove the source of the poisoning. Chelation treatment is applied in individuals with elevated blood lead levels, chelating agents bind to lead in the blood, facilitating their elimination by bile and urine, which reduces the total amount of lead in the body and its toxic effects.
The treatment for lead poisoning must be conducted by a multidisciplinary team. This is based on three pillars, which in order of importance are: elimination or reduction of the source of exposure, nutritional support and if necessary treatment with lead chelators.
Elimination of Source of Exposure:
The elimination of the source of exposure is the most important step in the lead poisoning treatment of intoxication. When the source of exposure is unclear, a thorough investigation of possible sources should be carried out. To reduce the dust that contains lead from home which is deposited on floors, window frames and doors, it must be removed with a cloth or sponge moistened with common or special detergent containing phosphates.
Other recommendations include: frequent hand washing of children especially before eating or sleeping, always keep the play area clean, bottles, pacifiers, toys and control the habit of pica (persistent and compulsive craving to ingest non-edible substances).
One study showed that parental counseling of the aforementioned measures proved to be effective in decreasing lead levels which were reduced by approximately 20%.
Providing a Balanced Diet:
Deficiencies of iron and calcium should be treated. Check that diet is balanced as this reduces the absorption of lead.
Treatment with Lead Chelators:
Lead poisoning treatment with chelators has decreased mortality. The used chelators are disodium calcium edetate (EDTA); dimercaprol (BAL) and the succimer (DMSA).
Symptomatic children and / or with lead levels of 70 μg / dl or more:
In this group, everyone should be considered a medical emergency and should be hospitalized for immediate lead poisoning treatment.
The lead poisoning treatment is started with BAL reaching a total daily dose of 450 mg / m2 divided into six doses. Three or four hours after starting lead poisoning treatment, continuous infusion of intravenous infusion is continued with EDTA 1,500 mg / m2 / 24 hours. The duration of the treatment is five days. The BAL is suspended when the blood lead drops to 60 μg / dl.
In some cases, treatment cycles must be carried out until the blood lead level drops to 20 μg / dl.
Asymptomatic children with lead levels of 45-69 μg / dl:
Everyone in this group must receive lead poisoning treatment. EDTA 100 mg / m2 / 24 hours is administered intravenously for five consecutive days.
Another lead poisoning treatment is DMSA, which is administered orally with few adverse effects. It is administered for five days at a rate of 350 mg / m2 every 8 hours, followed by an additional 14 days at a rate of 350 mg / m2 every 12 hours. If necessary, other treatment cycles can be administered at a two-week interval until the blood lead levels are less than 20 μg / dL.
Asymptomatic Children with Lead Levels between 20-45 μg / dl:
In this group, it is preferable to perform the EDTA challenge test for lead poisoning treatment, which assesses the usefulness of initiating chelation treatment.
The test consists of the administration of 500 mg / m2 of EDTA in an intravenous infusion for 30 minutes. Then collect the diuresis for the next 8 hours. The excreted lead is correlated with the EDTA administered according to the following formula: lead in urine (μg) / EDTA administered (mg). If the ratio is greater than 0.7, it is considered a positive (abnormal) result. This abnormal or positive result suggests that the treatment is indicated and that it will be effective. Results of the test with figures lower than 0.7 indicate that environmental control should be emphasized and subsequent controls carried out. The chelator to be used is EDTA at a rate of 1000 mg / m2 / 24 hours.
Asymptomatic Children with Lead Levels of 10-19 μg / dl:
The chelation treatment for lead poisoning treatment is not necessary: general education on prevention will be carried out and the sources of exposure will be controlled.