Consider lead poisoning if you see these symptoms
Cases are 'seen and missed' in EDs
If your patient tells you she is taking herbs or ayurvedic remedies, you may consider interactions with prescription drugs, but would you suspect lead poisoning?
Some of your patients may be taking herbal supplements that contain dangerous levels of lead, but symptoms of lead poisoning are likely to be overlooked in EDs, says Stefanos N. Kales, MD, MPH, FACP, FACOEM, medical director of employee and industrial medicine at Harvard School of Public Health. "Think about lead poisoning with differential diagnoses of abdominal pain, anemia, and other common ailments," he says.
Traditional remedies account for up to 30% of all childhood lead poisoning cases in the United States, according to the Centers for Disease Control and Prevention (CDC). The Environmental Protection Agency estimates 240,000 U.S. children were diagnosed with high blood lead levels from 2004 to 2006.
You might think that you haven't seen any lead poisoning cases in your ED, but this is probably because you haven't looked for them, says Kales. "Many cases have likely been seen and missed," he says. "The number of cases recognized will increase if nurses and doctors ask about these remedies."
If you fail to detect high levels of lead and the source of lead exposure continues, the patient would continue to be poisoned with all the associated potential complications, says Kales.
Symptoms vary widely
Any part of the central or peripheral nervous systems can be affected by lead intoxication, depending on the level and duration of exposure, with possible symptoms including edema, hemorrhage, vision and hearing loss, anemia, and renal failure, says Robert C. Knies Jr., RN, MSN, CNAA, BC, director of emergency services at Baptist Hospital East in Louisville, KY.
Since symptoms of lead poisoning can be vague, such as general malaise, cases aren't likely to be identified at triage, he adds. "It would be difficult to pick this up in the ED," Knies says. "The ED is under time pressure, and we don't have the privilege of doing the million-dollar work-up that we may want to do."
In some cases, patients may not report taking traditional remedies even if they are asked directly, adds Knies. "Also, you wouldn't know whether what they are taking has lead in it or not," he says. "Another thing is that ED nurses continue to learn more about symptoms from overdoses of herbals, but this lead exposure is occurring with normal use."
At triage, ask patients specifically about supplements, traditional remedies, and medications from home countries, recommends Kales. "When in doubt or suspicious, get a blood lead level on the patient," he says. "You have nothing to lose and will get an objective answer."
Sources
For more information on assessment of lead poisoning in the ED, contact:
- Stefanos N. Kales, MD, MPH, FACP, FACOEM, Director, Occupational & Environmental Medicine Residency, Harvard School of Public Health, Cambridge, MA. Phone: (617) 665-1580. Fax: (617) 665-1672. E-mail: [email protected].
- Robert C. Knies Jr., RN, MSN, CNAA, BC, Director of Emergency Services, Baptist Hospital East, Louisville, KY. Phone: (502) 897-8143. E-mail: [email protected].
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