Published recommendations (1985) for the management of childhood
lead poisoning suggest the use of
ethylenediaminetetraacetic acid (
EDTA) provocation testing and chelation as the mainstay of treatment for blood lead levels between 25 and 55 micrograms/dL. Since 1985 evidence has accumulated indicating that (1) levels of blood lead less than 25 micrograms/dL are detrimental to cognitive development, (2)
EDTA provocation testing may result in potentially harmful shifts in the body lead burden, and (3) oral agents such as
penicillamine and
2,3-dimercaptosuccinic acid are effective in reducing elevated lead levels. To determine how this evidence impacts on the management of childhood
lead poisoning, the authors surveyed the
lead poisoning clinics of pediatric departments in the cities estimated by the United States Public Health Service to have the largest number of children affected by
lead poisoning. Thirty (70%) of 43 surveys were completed. Respondents indicated that the lowest blood lead level for which they would use a
chelating agent to reduce the lead burden was as follows: 50 micrograms/dL (3%), 45 micrograms/dL (3%), 40 micrograms/dL (13%), 35 micrograms/dL (3%), 30 micrograms/dL (27%), 25 micrograms/dL (47%), and 20 micrograms/dL (3%). For all blood lead levels from 20 through 55 micrograms/dL,
EDTA was the most frequently recommended
chelating agent (chelation and provocation testing). Fifteen percent of responding lead clinics do not use the provocation test under any circumstances. For a child with a negative
EDTA provocation test, the percentage of respondents recommending the use of any
chelation therapy ranged from 16% for blood lead levels of 25 through 29 micrograms/dL to 66% for levels of 50 through 55 micrograms/dL.(ABSTRACT TRUNCATED AT 250 WORDS)