Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Current Practice and Pitfalls of Select Biomarkers in the Emergency Care of Children right.
Case Presentation: Lead Poisoning in Children: Emergency Department Recognition and Management
A 4-year-old boy with a history of autism spectrum disorder presents to the ED with a chief complaint of abdominal pain…
The patient is nonverbal, but his mom states that he is inter mittently holding his abdomen and crying. He has not had fever or emesis. He has not stooled in 10 days. The mom tells you that he has been constipated “since he was a baby,” and it has been managed with polyethylene glycol, but he has never gone this long without stooling. The patient has a decreased appetite, but his urine output has been normal. On further questioning, the mom says that her son has pica behaviors and that their apartment was recently renovated.
On physical examination, you note that the patient appears comfortable, but has a slightly distended abdomen with generalized tender ness, without rebound or guarding. You discuss with the mom your concer n that his symptoms may be due to lead poisoning. You relay the plan to obtain a blood lead level.
What risk factors for lead poisoning does this patient have? What other tests should you consider as part of your initial workup? How much of this workup needs to be done in the ED? How will you determine whether the patient needs to be admitted?
The boy had a BLL of 83 mcg/dL. Other laboratory tests were significant for microcytic anemia. An abdominal radiograph showed no foreign body. The regional PEHSU was contacted via pehsu.net to help develop a management plan. An environmental health specialist working at the regional PEHSU recommended treating the boy with combination therapy of succimer and CaNa2EDTA, with adjunctive intravenous hydration. The patient was admitted to the ICU for treatment. City public health officials visited the patient’s home and found evidence of lead dust throughout. They made a plan to start lead abatement in the home and discharged the patient to a lead-free safe house once his medical treatment was complete.
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Last Updated on January 26, 2023