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Lead Toxicity

Pathway Background and Objectives

Lead poisoning in children leads to negative neurocognitive and developmental outcomes. While severe lead poisoning requiring chelation is increasingly rare, elevated blood lead levels in children remain prevalent in Connecticut due to the State’s older housing stock. An estimated 2.7% of children in Connecticut are lead poisoned. Fortunately, very few of these children have high enough blood lead levels to merit chelation therapy. In 2015, there were only 14 cases of lead poisoning that required chelation therapy. As chelation becomes a rare event and fewer providers have experience with therapy, it is important to ensure that all patients are treated with the same protocol. The Hartford and New Haven lead treatment centers have developed the following oral and IV chelation guidelines based on Center for Disease Control and American Academy of Pediatrics recommendations. All children in Connecticut receive the same chelation protocols regardless of treatment facility.

The objectives of this pathway are to:

  • Create a systematic way to manage patient with lead toxicity
  • Outline the initial work up of patients with lead toxicity
  • Outline the important considerations prior to starting chelation therapies, if indicated
  • Identify the correct chelation therapy and appropriate monitoring during treatment
  • Help facilitate discharge in a timely fashion

Algorithm

Download Lead Toxicity Pathway Algorithm

Quality Metrics

  • Percentage of patients with order set usage
  • Percentage of patients with a venous lead level drawn at admission (if no results available from previous 72 hours)
  • Percentage of patients who have venous lead level drawn at discharge
  • Percentage of patients who have ZPP level drawn during encounter
  • Percentage of patients who have urine specific gravity checked each shift
  • Percentage of patients with hydration needs ordered per pathway
  • Percentage of patients with Lead Team consult placed
  • Percentage of patients with discharge chelation medication prescription delivered to bedside
  • Percentage of patients with Lead Clinic follow-up appointment made at discharge

Educational Module

Download Lead Toxicity Educational Module

Key Tools

Requirements and Guidance for Childhood Lead Screening by Health Care Professionals in Connecticut Lead Poisoning and Prevention and Control Program. Connecticut Department of Public Health. Revised 2013.

Key References

Pathway Contacts

Patricia Garcia, MD
Jennifer Haile, MD

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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