Six children with lead poisoning

Although most commonly seen in children from lower socioeconomic backgrounds, all children are at risk for lead poisoning. Management is a potential problem for all primary care providers. Because few individuals in the primary care practice of pediatrics have many patients with lead poisoning, it may be difficult to understand the nuances of management. We describe six patients, each of whom reflects different aspects of lead poisoning in children, and discuss the lessons we have learned in the course of their treatment. We have found that graphic representation of the blood lead and erythrocyte protoporphyrin values is helpful in the longitudinal follow-up of these youngsters.     

正确认识儿童铅中毒

近年来,我国的儿童铅中毒防治工作受到了有关政府部门、儿科医师和儿童保健工作者及社会各界的广泛关注和重视,各地纷纷成立了各种儿童铅中毒防治机构,进行儿童铅中毒的防治工作;有些地区在筛查的基础上发现了部分高血铅儿童,并且进行了相应的干预;通过筛查也发现了不少铅污染严重地区,揭示了部分地区环境铅污染问题的严重性,进而引起了当地政府的高度重视,关停并转了污染严重的企业,降低了环境铅污染程度;尤其是20世纪90年代后期在全国推广使用无铅汽油以来,儿童血铅水平持续下降,儿童铅中毒防治取得了实质性进步,在国内、国外产生了积极的影响。但是,我们也应该看到,我国的儿童铅中毒防治工作还存在不少问题,有些问题是属于认识方面的偏差。     

Hazards of 'deleading' homes of children with lead poisoning

"Deleading" the homes of children with lead poisoning is a necessary step to terminate the child's exposure to lead. Lead poisoning as a result of lead exposure during the process of deleading has occurred in deleading workers but has not been well documented among children whose homes are deleaded. We treated four children with classes I through III lead poisoning (range of blood lead [Pb-B] level, 1.6 to 2.75 mumol/L [33 to 57 micrograms/dL]) who had significant elevation of their Pb-B levels (range, peak 4.34 to 6.27 mumol/L [90 to 130 micrograms/dL]) following deleading of their homes. The methods used for deleading included scraping, sanding, and burning of the paint. Symptoms included irritability (n = 3) and vomiting (n = 1). The elevation of the Pb-B levels was detected early, allowing prompt chelation therapy. Because exacerbation of lead poisoning may occur in children following deleading of their homes, safer approaches of deleading should be determined.     

Maternal perceptions of lead poisoning in children with normal and elevated lead levels.

INTRODUCTION: The purpose of this study was to examine mothers' perceptions of the severity and susceptibility of their children to lead poisoning and to determine if a correlation existed between mothers' knowledge of lead poisoning and their children's blood lead levels. It was thought that mothers of children with lead poisoning (lead levels > or = 10 micrograms/dL) would score lower on a test of their perceptions and knowledge of lead poisoning than would mothers of children with normal lead levels (lead levels < or = 9 micrograms/dL). METHOD: A cross-sectional study comparing scores of a questionnaire completed by mothers whose children had elevated blood lead levels and mothers whose children had normal blood lead levels was conducted. RESULTS: No difference was found in the median test score between the 2 groups. For the correct responses on a question-by-question comparison, significant difference existed between groups; however, the percentage of correct responses was not always greater for the mothers of children with normal blood lead levels. DISCUSSION: Mothers' perceptions and knowledge of lead poisoning were not associated with their children's blood lead levels.     

Interaction of iron deficiency and lead and the hematologic findings in children with severe lead poisoning

Microcytic anemia, long considered an effect of lead poisoning, may in fact result from coexisting iron deficiency. In this study, how RBC size, hemoglobin, and zinc protoporphyrin vary as a function of iron status in a group of children with high lead levels was examined. Charts of all children (N = 51) admitted to Cook County Hospital for treatment of lead poisoning in 1981 to 1983 were reviewed for data on age, blood lead level, hemoglobin concentration, MCV, transferrin saturation and zinc protoporphyrin level. The mean lead level was 86 micrograms/dL and the range was 63 to 190 micrograms/dL. Children with transferrin saturation values less than 7% had a mean MCV of 56 microL, hemoglobin of 8.9 g/dL, and zinc protoporphyrin of 693 micrograms/dL; for those with saturations of 7% to 16%, the values were 61 microL, 10.1 g/dL, and 581 micrograms/dL, respectively; the children with saturations greater than 16% had normal mean MCVs and hemoglobin concentrations (74 microL and 11.4 g/dL) and a mean zinc protoporphyrin value of 240 micrograms/dL (P less than .0005). Multiple linear regression was used to correct for effect of age, and transferrin saturation remained the most important predictor of MCV, hemoglobin, and zinc protoporphyrin levels; the addition of lead did not improve the models. Results of this study suggest that iron deficiency is strongly associated with some of the observed toxicities of lead. Also, lead poisoning can exist without producing microcytosis or anemia, and zinc protoporphyrin concentration may not be a sensitive indicator of lead level in the absence of iron deficiency.     

儿童高铅血症和轻度铅中毒458例临床分析

目的 了解本地区儿童血铅水平,高铅血症患儿的临床症状、铅接触情况,以进一步防治儿童铅中毒.方法 对门诊2年中3 298例12岁以内儿童的血铅筛查资料进行归纳、分析.结果 发现高铅血症患儿399例,铅中毒59例.血铅平均水平(150.05±37.17)mg/L,均为高铅血症及轻度铅中毒,多数患儿能找出铅暴露危险因素,中毒的程度似与多重危险因素相关.所有患儿均给予去除铅暴露危险因素、营养指导等处理,2～3个月后复查,其血铅水平均有不同程度下降.结论 对儿童血铅水平的筛查,能及早发现儿童高血铅及铅中毒,达到及时干预和治疗的目的 .     

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我国是世界上人口最多的国家,约有3亿(~14岁)少年儿童,其中对铅毒性作用敏感的人群(~6岁儿童、孕产妇)约1·2亿。目前,铅中毒对我国儿童健康已产生不良影响。近几年来,我国发表的有关儿童铅中毒研究的文章中,一半以上的内容涉及到铅对我国儿童智能、心理行为、生长发育或其他器官发生的不良影响。我国儿童接触铅污染的机会日益增多。我国长期以来一直使用含铅汽油,随着汽车交通业迅速膨胀,铅尘排放已成为持久的污染源。近年来工厂尤其是乡镇企业的大量兴起,通过废气、废水、废渣的排放,使铅污染由城市逐步向外扩展。通过室内装修、吸烟、印…     

Early tubular involvements in lead poisoning in children]

One of the main targets of lead poisoning is the kidney. Chronic poisoning can lead to kidney failure, and acute poisoning to tubulopathy with Toni-Debré-Fanconi syndrome. The primum movens of this tubulopathy is a distortion of mitochondrial energetic metabolism. We studied 27 children presenting with non symptomatic poisoning. Serum creatinine levels were normal. There was neither proteinuria nor glycosuria and only one child presented with hyperaminoaciduria. One third already presented with signs of tubulopathy, as shown by an increase in beta 2 microglobinuria in 36.5% of the cases studied (8 times in 22 samples) and enzymuria in 30.4% of the cases (23.5% if one excludes the children having had a chelation before the study). Kidney is therefore involved early in lead poisoning in children.     

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儿童铅中毒的处理应该遵循健康教育和环境干预为主,药物驱铅治疗为辅的原则。当儿童血铅经静脉血复查仍高于或等于450μg/L时,应在脱离铅污染源的情况下采用药物进行驱铅治疗。儿童血铅处于250~449μg/L时,部分儿童可以采用药物进行驱铅治疗,近年的研究发现对于这部分儿童采用驱铅治疗后智力发育并没有明显改善,因此美国儿科学会最近提出中度儿童铅中毒驱铅治疗没有意义[1]。根据文献报道,在我国目前除铅污染区外,绝大多数普通城市及乡村儿童的血铅高于或等于100μg/L的比例为10%~30%,高于200μg/L的比例低于1%~2%,较10年前有较明显的下降…     

珠海市铅中毒儿童贫血发生率的调查

目的　了解珠海市铅中毒对儿童贫血发生率的影响。方法　根据 5 4 0名儿童血铅 (BPb)测定水平 ,将其分成非铅中毒组 (BPb <10 0 μg/L)和铅中毒组 (BPb≥ 10 0 μg/L) ,同时进行两组血细胞分析 ,测定红细胞 (RBC)、血红蛋白 (Hb)、红细胞平均容积 (MCV)、红细胞平均血红蛋白 (MCH)、红细胞平均血红蛋白浓度(MCHC)水平。结果　两组RBC、Hb、MCV、MCH、MCHC水平差异无显著性 (P均 >0 .0 5 )。结论　较低水平铅中毒患儿贫血发生率无显著升高。