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California Childhood Lead Poisoning Prevention Branch: Provider Outreach

Treatment Matrix

The local childhood lead poisoning prevention program (CLPPP) serves as the primary resource for the practitioner (eg. case management, staff-in service training, educational materials, environmental investigations and on-site fingerstick sampling programs). The following categories represent general guidelines. Primary management of lead poisoning is source identification and removal from exposure. Recommendations for medical treatment of children and adults differ significantly. Treatment decisions should be made in consultation with a physician knowledgeable about lead poisoning medical management.

Management Guidelines For Blood Lead Levels In Children and Adults

BLOOD LEAD LEVELS (BLLs) IN CHILDREN

Blood Lead (µg/dL)*  Management**
<10 Anticipatory guidance.
10-14 Guidance, nutrition evaluation, & lead-exposure history. Retest in 3 months.
15-19 Guidance, nutrition evaluation, & lead-exposure history. Retest in 1 to 2 months. Consider hgb/hct. Treat persistent BLLs of 15-19 µg/dL as for 20-44 µg/dL.
20-44 Guidance, nutrition evaluation, lead-exposure history, psychosocial & neuro-development status. Public health referral for case management & environmental investigation.*** Depending on BLL, retest in 1 week to 1 month. Order hgb/hct.
45-69 Guidance, nutrition evaluation, lead-exposure history, psychosocial & neuro-development status. Public health referral, as above.*** Retest 45-59 µg/dL in 48 hours & 60-69 µg/dL in 24 hours. Order hgb/hct. Consider chelation.
70 and above Medical emergency. Immediately hospitalize, retest, & chelate. Refer as above.***


*Screening may be on capillary specimens. Confirmatory and follow-up BLLs should be on venous draws.
**See Centers for Disease Control & Prevention (CDC), Managing Elevated Blood Lead Levels Among Young Children. Atlanta, GA: US Dept. of Health and Human Services, March 2002.
***Contact the local childhood lead poisoning prevention program or the Health Officer, California Department of Public Health, Childhood Lead Poisoning Prevention Branch, (510) 620-5600.

BLOOD LEAD LEVELS IN ADULTS

Blood Lead (µg/dL)  Management
   <10 No action needed.
10-24 Identify and minimize lead exposure. Remove from exposure if pregnant.
25-49 Remove from exposure if symptomatic. Monitor blood lead and zinc protoporphyrin. Medical evaluation required by OSHA if BLL > or equal to 40 µg/dl.
50-79 Remove from work with lead. Immediate medical evaluation indicated. Chelation not indicated unless significant symptoms due to lead poisoning.
80 and above As above. Chelation may be indicated if symptomatic. Important to consult on individual case basis (see below).

Consult Cal/OSHA General Industry and Construction Lead Standards for occupational exposure.

For more information, call the California Department of Public Health, Occupational Lead Poisoning Prevention Program at (510) 620-5757, or your nearest University of California Occupational and Environmental Health Clinic (San Diego, Irvine, Los Angeles, San Francisco and Sacramento).

 

 
 
Last modified on: 1/24/2008 9:20 AM