Lead Toxicity Clinical Pathway

Pathway Background and Objectives

Lead poisoning in children leads to negative neurocognitive and developmental outcomes. While severe lead poisoning requiring chelation is increasingly rare, elevated blood lead levels in children remain prevalent in Connecticut due to the State’s older housing stock. In 2020, lead poisoning prevalence was 1.67% and incidence was 1.08%. Fortunately, very few of these children have high enough blood lead levels to merit chelation therapy. In 2020, there were only 6 cases of lead poisoning that required chelation therapy. As chelation becomes a rare event and fewer providers have experience with therapy, it is important to ensure that all patients are treated with the same protocol. The Hartford and New Haven lead treatment centers have developed the following oral and IV chelation guidelines based on Center for Disease Control and American Academy of Pediatrics recommendations. All children in Connecticut receive the same chelation protocols regardless of treatment facility.

The objectives of this pathway are to:

Create a systematic way to manage patient with lead toxicity
Outline the initial work up of patients with lead toxicity
Outline the important considerations prior to starting chelation therapies, if indicated
Identify the correct chelation therapy and appropriate monitoring during treatment
Help facilitate discharge in a timely fashion

Algorithm Educational Module

Key References

Connecticut Department of Public Health. (2023). Requirements and Guidance for Childhood Lead Screening for Healthcare Providers in Connecticut.https://portal.ct.gov/-/media/dph/ehdw/childhood-lead-poisoning-prevention/healthcare-provider-guidance-3-1-24.pdf.
Connecticut Department of Public Health. (2020). 2020 Executive Summary: Childhood Lead Poisoning Surveillance. https://portal.ct.gov/-/media/DPH/EHDW/Childhood-Lead-Poisoning-Prevention/Executive-Summary-of-CT--2020-Childhood-Lead-Poisoning-Surveillance-Report-and-prev-data-tables.pdf.
Newman, N., Binns, H.J., Karwowski, M., Lowry, J., PEHSU Lead Working Group. (2013). Recommendations on Medical Management of Childhood Lead Exposure and Poisoning. American Academy of Pediatrics & Pediatric Environmental Health Specialty Units. https://www.pehsu.net/_Library/facts/medical-mgmnt-childhood-lead-exposure-June-2013.pdf.
Advisory Committee on Childhood Lead Poisoning Prevention. (2002). Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/nceh/lead/casemanagement/managingEBLLs.pdf.

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.