0
September 1987, Vol 141, No. 9 >
Article | September 1987

The Hazards of Benign(?) Neglect of Elevated Blood Lead Levels FREE

Herbert L. Needleman, MD; John Rosen, MD; Philip Landrigan, MD; John Graef, MD
Am J Dis Child. 1987;141(9):941-942. doi:10.1001/archpedi.1987.04460090018010.
Text Size: A A A
Published online
Article
References
Comments

Sir.—In a recent clinical report, Moel et al1 detailed the decline in blood lead (Pb-B) levels of 74 patients treated for lead toxicity. They argue that it is unnecessary and perhaps even unwise to chelate children once Pb-B levels have dropped below 2.41 (50 μg/dL). The effect of this advice, if followed, would be to allow large numbers of children to bear body lead burdens in the toxic range for periods of time that most investigators and experienced clinicians would consider dangerously prolonged.

The authors based their conclusion that repeated courses of chelation are unnecessary on the following assertions: (1) that Pb-B levels in their patients eventually declined to below 1.21 μmol/L (25 μg/dL) (it takes about ten years to reach this level); (2) that no significant difference was found in mean postchelation Pb-B levels between groups classified by number of chelations; (3) that the nephrotoxic effects of

REFERENCES

1 +
Moel DI, Sachs HK, Drayton MA:  Slow, natural reduction in blood lead level after chelation therapy for lead poisoning in childhood . AJDC 1986;;140:905-908.
2 +
Yule W, Rutter M:  Effect of lead on children's behavior and cognitive performance: A critical review , in Mahaffey K (ed): Dietary and Environmental Lead: Human Health Effects . Amsterdam, Elsevier Science Publishers, 1985;.
3 +
Grant L, Davis M: Effects of low-level lead exposure on pediatric neurobehavioral and physical development: Current findings and future directions. Presented at the Workshop on Lead and Neurobehavioral Effects in Children, Edinburgh, Sept 8-12, 1986.
4 +
Preventing Lead Poisoning in Children . Atlanta, Centers for Disease Control, 1984;.
5 +
Rosen J:  Metabolic and cellular effects of lead: A guide to low-level lead toxicity in children , in Mahaffey K (ed): Dietary and Environmental Lead: Human Health Effects . Amsterdam, Elsevier Science Publishers, 1985;.
6 +
Piomelli S:  The effects of low-level lead exposure on heme metabolism , in Needleman H (ed): Low-Level Lead Exposure: The Clinical Implications of Current Research . New York, Raven Press, 1980;.
7 +
Rosen JF, Chesney RW, Hamstra T, et al:  Reduction in 1,25-dihydroxy vitamin D in children with increased lead absorption . N Engl J Med 1980;;302:1128-1131.
Link to Article
8 +
Angle CR, McIntire MS:  Low-level lead and inhibition of erythrocyte pyrimidine nucleotidase . Environ Res 1978;;17:296-302.
Link to Article
9 +
Schwartz J, Angle C, Pitcher H:  The relation between childhood blood lead and stature . Pediatrics 1986;;77:281-288.
10 +
Moel D, Kumar K:  Reversible nephrotoxic reactions to a combined 2,3-dimercapto-1-propanol and calcium disodium ethylenediaminetetraacetic acid regimen in asymptomatic children with elevated blood lead levels . Pediatrics 1982;; 70:259-262.
11 +
Sachs H, Krall V, McCaughran D, et al:  IQ following treatment of lead poisoning: A patient-sibling comparison . J Pediatr 1978;;93:428-431.
Link to Article
12 +
SchwartzJ, Pitcher H, Levin R, et al: Costs and Benefits of Reducing Lead in Gasoline: Final Regulatory Impact Analysis. Office of Policy Analysis , US Environmental Protection Agency, 1985;.
13 +
Needleman H, Bellinger D: Type II fallacies in the study of childhood exposure to lead at low dose: A critical and quantitative review. Presented at the Workshop on Lead and Neurobehavioral Effects in Children, Edinburgh, Sept 8-12, 1986.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Moel DI, Sachs HK, Drayton MA:  Slow, natural reduction in blood lead level after chelation therapy for lead poisoning in childhood . AJDC 1986;;140:905-908.
2 +
Yule W, Rutter M:  Effect of lead on children's behavior and cognitive performance: A critical review , in Mahaffey K (ed): Dietary and Environmental Lead: Human Health Effects . Amsterdam, Elsevier Science Publishers, 1985;.
3 +
Grant L, Davis M: Effects of low-level lead exposure on pediatric neurobehavioral and physical development: Current findings and future directions. Presented at the Workshop on Lead and Neurobehavioral Effects in Children, Edinburgh, Sept 8-12, 1986.
4 +
Preventing Lead Poisoning in Children . Atlanta, Centers for Disease Control, 1984;.
5 +
Rosen J:  Metabolic and cellular effects of lead: A guide to low-level lead toxicity in children , in Mahaffey K (ed): Dietary and Environmental Lead: Human Health Effects . Amsterdam, Elsevier Science Publishers, 1985;.
6 +
Piomelli S:  The effects of low-level lead exposure on heme metabolism , in Needleman H (ed): Low-Level Lead Exposure: The Clinical Implications of Current Research . New York, Raven Press, 1980;.
7 +
Rosen JF, Chesney RW, Hamstra T, et al:  Reduction in 1,25-dihydroxy vitamin D in children with increased lead absorption . N Engl J Med 1980;;302:1128-1131.
Link to Article
8 +
Angle CR, McIntire MS:  Low-level lead and inhibition of erythrocyte pyrimidine nucleotidase . Environ Res 1978;;17:296-302.
Link to Article
9 +
Schwartz J, Angle C, Pitcher H:  The relation between childhood blood lead and stature . Pediatrics 1986;;77:281-288.
10 +
Moel D, Kumar K:  Reversible nephrotoxic reactions to a combined 2,3-dimercapto-1-propanol and calcium disodium ethylenediaminetetraacetic acid regimen in asymptomatic children with elevated blood lead levels . Pediatrics 1982;; 70:259-262.
11 +
Sachs H, Krall V, McCaughran D, et al:  IQ following treatment of lead poisoning: A patient-sibling comparison . J Pediatr 1978;;93:428-431.
Link to Article
12 +
SchwartzJ, Pitcher H, Levin R, et al: Costs and Benefits of Reducing Lead in Gasoline: Final Regulatory Impact Analysis. Office of Policy Analysis , US Environmental Protection Agency, 1985;.
13 +
Needleman H, Bellinger D: Type II fallacies in the study of childhood exposure to lead at low dose: A critical and quantitative review. Presented at the Workshop on Lead and Neurobehavioral Effects in Children, Edinburgh, Sept 8-12, 1986.

Correspondence

Submit a Letter
CME
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Clear Answers | Save For Later
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2013 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems