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December 1987, Vol 141, No. 12 >
Article | December 1987

An Analysis of 248 Initial Mobilization Tests Performed on an Ambulatory Basis FREE

Howard L. Weinberger, MD; Ernest M. Post, MD; Thelma Schneider, RN; Brenda Helu; John Friedman, MD
[+] Author Affiliations

Accepted for publication June 29, 1987.

Reprint requests to Department of Pediatrics, State University of New York Health Science Center at Syracuse, 750 E Adams St, Syracuse, NY 13210 (Dr Weinberger).


Am J Dis Child. 1987;141(12):1266-1270. doi:10.1001/archpedi.1987.04460120028025.
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• Data are presented on 248 initial mobilization tests performed in an ambulatory setting over an 11-year period. Results demonstrate that there is no single, consistent predictor of body burden of lead, although the higher the blood lead level, the greater the amount of excretable (mobilizable) lead. It is recommended that an appropriate ratio of lead excreted in response to chelant Is equal to or greater than 0.5 based on this series of tests. A recommendation is also made to realign the Centers for Disease Control (Atlanta) guidelines for classification of risk. This realignment would coincide with a recommendation that mobilization tests be reserved for children whose blood lead levels ranged from 1.93 to 2.57 µmol/L (40 to 60 µg/dL). Those with higher levels would undergo chelation without prior mobilization studies.

(AJDC 1987;141:1266-1270)

REFERENCES

1 +
Lin-Fu JS:  Lead poisoning and undue lead exposure in children: History and current status , in Needleman HL (ed): Low Level Lead Exposure: The Clinical Implications of Current Research . New York, Raven Press, 1980;, pp 5-16.
2 +
Mahaffey KR, Annest JL, Roberts J, et al:  National estimates of blood lead levels: United States, 1976-1980: Association with selected demographic and socioeconomic factors . N Engl J Med 1982;;307:573-579.
3 +
Needleman HL, Gunnoe C, Leviton A, et al:  Deficits in psychologic and classroom performance of children with elevated dentine lead levels . N Engl J Med 1979;;300:689-695.
4 +
Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Centers for Disease Control, April 1978;.
5 +
Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Centers for Disease Control, (January) 1985;.
6 +
Graef JW:  Outpatient use of a six-hour lead mobilization test in chelation therapy . Pediatr Res 1976;;10:330.
7 +
Markowitz ME, Rosen JF:  Assessment of lead stores in children: Validation of an eight-hour CaNa2EDTA provocative test . J Pediatr 1984;;104:337-341.
8 +
Piomelli S, Rosen JF, Chisolm JJ Jr, et al:  Management of childhood lead poisoning . J Pediatr 1984;;105:523-532.
9 +
Mitchell DG, Aldous KM, Ryan RJ:  Mass screening for lead poisoning: Capillary blood sampling and Delves cup atomic absorption analysis . NY State Med J 1974;;74:1599.
10 +
Hessell DW:  A simple and quantitative determination of lead in blood . Atomic Absorption Newsletter 1968;;7:55.
11 +
Piomelli S:  A micromethod for free erythrocyte protoporphyrins: The FEP test . J Lab Clin Med 1973;;81:932.
12 +
Yip R, Schwartz S, Deinard AS:  Screening for iron deficiency with the erythrocyte protoporphyrin test . Pediatrics 1983;;72:214-219.
13 +
Piomelli S, Lamola AA, Poh-Fitzpatrick MB, et al:  Erythropoietic protoporphyria and lead intoxication: The molecular basis for difference in cutaneous photosensitivity: I. Different rates of disappearance of protoporphyrin from the erythrocytes, both in vivo and in vitro . J Clin Invest 1975;;56:1519-1527.
14 +
Foreman H, Trujillo TT:  The metabolism of 14C-labeled ethylenediamine tetra-acetic acid in human beings . J Lab Clin Med 1954;;43:566.
15 +
Saenger P, Rosen JF, Markowitz M:  Diagnostic significance of edetate disodium calcium testing in children with increased lead absorption . AJDC 1982;;136:312-315.

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References

1 +
Lin-Fu JS:  Lead poisoning and undue lead exposure in children: History and current status , in Needleman HL (ed): Low Level Lead Exposure: The Clinical Implications of Current Research . New York, Raven Press, 1980;, pp 5-16.
2 +
Mahaffey KR, Annest JL, Roberts J, et al:  National estimates of blood lead levels: United States, 1976-1980: Association with selected demographic and socioeconomic factors . N Engl J Med 1982;;307:573-579.
3 +
Needleman HL, Gunnoe C, Leviton A, et al:  Deficits in psychologic and classroom performance of children with elevated dentine lead levels . N Engl J Med 1979;;300:689-695.
4 +
Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Centers for Disease Control, April 1978;.
5 +
Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Centers for Disease Control, (January) 1985;.
6 +
Graef JW:  Outpatient use of a six-hour lead mobilization test in chelation therapy . Pediatr Res 1976;;10:330.
7 +
Markowitz ME, Rosen JF:  Assessment of lead stores in children: Validation of an eight-hour CaNa2EDTA provocative test . J Pediatr 1984;;104:337-341.
8 +
Piomelli S, Rosen JF, Chisolm JJ Jr, et al:  Management of childhood lead poisoning . J Pediatr 1984;;105:523-532.
9 +
Mitchell DG, Aldous KM, Ryan RJ:  Mass screening for lead poisoning: Capillary blood sampling and Delves cup atomic absorption analysis . NY State Med J 1974;;74:1599.
10 +
Hessell DW:  A simple and quantitative determination of lead in blood . Atomic Absorption Newsletter 1968;;7:55.
11 +
Piomelli S:  A micromethod for free erythrocyte protoporphyrins: The FEP test . J Lab Clin Med 1973;;81:932.
12 +
Yip R, Schwartz S, Deinard AS:  Screening for iron deficiency with the erythrocyte protoporphyrin test . Pediatrics 1983;;72:214-219.
13 +
Piomelli S, Lamola AA, Poh-Fitzpatrick MB, et al:  Erythropoietic protoporphyria and lead intoxication: The molecular basis for difference in cutaneous photosensitivity: I. Different rates of disappearance of protoporphyrin from the erythrocytes, both in vivo and in vitro . J Clin Invest 1975;;56:1519-1527.
14 +
Foreman H, Trujillo TT:  The metabolism of 14C-labeled ethylenediamine tetra-acetic acid in human beings . J Lab Clin Med 1954;;43:566.
15 +
Saenger P, Rosen JF, Markowitz M:  Diagnostic significance of edetate disodium calcium testing in children with increased lead absorption . AJDC 1982;;136:312-315.

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