Dr. Marissa Hauptman, Co-director of Boston Children’s Hospital Pediatric Environmental Health Center, discusses lead screening, elevated lead levels, and taking an environmental exposure history. They cover the importance of lead screening in young children and the risks of lead exposure on brain development. The podcast also addresses factors contributing to lead exposure, health disparities, lead poisoning symptoms, treatment with chelation therapy, and supporting healthy housing.
Pediatric lead screening is crucial for secondary prevention and managing elevated blood lead levels in children.
Assessing environmental exposure history is essential in determining lead exposure and reducing lead hazards in homes.
Chelation therapy, such as calcium disodium edetate and succimer, plays a vital role in managing elevated lead levels, but careful monitoring is necessary due to potential nephrotoxicity and hepatotoxicity.
Deep dives
Pediatric Lead Screening and Treatment
In this podcast episode, Dr. Marissa Halpman discusses the importance of pediatric lead screening and treatment. She emphasizes the need for secondary prevention and highlights the estimated number of children in the US with elevated blood lead levels. Dr. Halpman explains the significance of an environmental exposure history in assessing lead exposure. She emphasizes the importance of reducing lead exposure in homes, such as addressing lead-based paint hazards and contaminated soil. Dr. Halpman also discusses the signs and symptoms of acute lead poisoning and the various tests and chelation therapy options available for managing elevated lead levels.
Taking an Environmental Exposure History
Dr. Marissa Halpman explains the mnemonic 'HOM' for taking an environmental health history, focusing on housing conditions, water sources, mold, air quality, pests, and other potential sources of lead exposure. She discusses the importance of nutritional status and developmental history when assessing lead exposure. Dr. Halpman also provides recommendations for families, such as covering up chipping paint, frequent wet mopping, handwashing, and getting a certified lead inspection for homes. She addresses health disparities in lead exposure, highlighting environmental racism.
Chelation Therapy and Managing Acute Lead Poisoning
Dr. Marissa Halpman explains the process and importance of chelation therapy in managing elevated lead levels. She discusses the different chelation options, including British anti-Lewisite, calcium disodium edetate, and dimercaptosuccinic acid. Dr. Halpman highlights the challenges posed by drug shortages and recalls in accessing these therapies. She also mentions the need for GI decontamination and the role of baseline tests, such as CBC, zinc protoporphyrin level, and abdominal x-ray. Dr. Halpman emphasizes the collaborative approach involving hospitalization, monitoring, and reducing ongoing lead exposure during treatment.
Lead exposure in communities and environmental inequities
Lead exposure in children is influenced by environmental inequities, environmental justice, and environmental racism. Studies show a dose-response relationship between the proportion of old housing stock, poverty, and the risk of lead exposure in children. The impact of lead exposure is compounded in impoverished communities with multiple stressors. Families with limited resources and language barriers face challenges in accessing help from the Department of Public Health to address lead exposure.
Treatment and monitoring of lead exposure
Chelation therapy, such as calcium disodium edetate and succimer, is used for treating lead poisoning. Calcium disodium edetate is potentially nephrotoxic, requiring careful monitoring of urine for blood, protein, and leukocytes. Succimer can be hepatotoxic, so monitoring liver function is important. After an inpatient stay, oral chelation therapy is initiated for a 21-day course, followed by periodic lead level checks. It may take up to a year of on-and-off treatment to reduce lead levels below 20, with ongoing evaluations of the home environment.
In this episode, our guest Dr. Marissa Hauptman teaches us why we screen for lead exposure, what to do with an elevated lead level, and how to take an environmental exposure history. Dr. Hauptman is the co-director for the Boston Children’s Hospital Pediatric Environmental Health Center, where she provides care for children with lead, asthma, and other environmental exposures.
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