Lead Paint Removal >> Lead Paint Poisoning In Children

Physical examination should emphasize the neurological, gastrointestinal, and cardiovascular systems. The worker's weight and blood pressure should be recorded and the oral mucosa checked for pigmentation characteristic of a possible Burtonian or lead line on the gingiva.It should be noted, however, that the lead line may not be present even in severe lead poisoning if good oral hygiene is Lead Paint Poisoning In Children practiced. 

The presence of pallor on skin examination may indicate an anemia which, if severe, might also be associated with a tachycardia.If an anemia is suspected, Lead Paint Poisoning In Children an active search for blood loss should be undertaken including potential blood loss through the gastrointestinal tract. 

A complete neurological examination should include an adequate mental status evaluation including a search for behavioral and psychological disturbances, memory testing, evaluation for irritability, insomnia, hallucinations, and Lead Paint Poisoning In Children mental clouding. Gait and coordination should be examined along with close observation for tremor. 

A detailed evaluation of peripheral nerve function including careful sensory and motor function testing is warranted. Strength testing particularly of extensor muscle groups of all extremities is of fundamental importance. Cranial nerve evaluation should also be included in the routine examination. The abdominal examination should include auscultation for bowel sounds and abdominal bruits and palpation for organomegaly, masses, and Lead Paint Poisoning In Children diffuse abdominal tenderness. 

Cardiovascular examination should evaluate possible early signs of congestive heart failure. Pulmonary status should be addressed particularly if respirator protection is contemplated. As part of the medical evaluation, the interim lead standard requires the following laboratory studies: 1. Blood lead level 2. Hemoglobin and hematocrit determinations, red cell indices, Lead Paint Poisoning In Children and examination of the peripheral blood smear to evaluate red blood cell morphology 

3. Blood urea nitrogen 4. Serum creatinine 5. Routine urinalysis with microscopic examination 6. A zinc protoporphyrin level. In addition to the above, Lead Paint Poisoning In Children the physician is authorized to order any further laboratory or other tests which he or she deems necessary in accordance with sound medical practice. The evaluation must also include pregnancy testing or laboratory evaluation of male fertility if requested by the employee. 

Additional tests which are probably not warranted on a routine basis but may be appropriate when blood lead and ZPP levels are equivocal include delta aminolevulinic acid and Lead Paint Poisoning In Children coproporphyrin concentrations in the urine, and dark-field illumination for detection of basophilic stippling in red blood cells. 

If an anemia is detected further studies including a careful examination of the peripheral smear, reticulocyte count, stool for occult blood, serum iron, total iron binding capacity, bilirubin, and, if appropriate, vitamin B12 and folate may be of value in attempting to identify the cause of the anemia. If a peripheral neuropathy is suspected, Lead Paint Poisoning In Children nerve conduction studies are warranted both for diagnosis and as a basis to monitor any therapy. 

If renal disease is questioned, a 24-hour urine collection for creatinine clearance, protein, and Lead Paint Poisoning In Children electrolytes may be indicated. Elevated uric acid levels may result from lead-induced renal disease and a serum uric acid level might be performed. An electrocardiogram and chest x-ray may be obtained as deemed appropriate. 

Sophisticated and highly specialized testing should not be done routinely and where indicated should be under the direction of a specialist. IV. Laboratory Evaluation The blood lead level at present remains the single most important test to monitor lead exposure and Lead Paint Poisoning In Children is the test used in the medical surveillance program under the lead standard to guide employee medical removal. 

The ZPP has several advantages over the blood lead level. Because of its relatively recent development and Lead Paint Poisoning In Children the lack of extensive data concerning its interpretation, the ZPP currently remains an ancillary test. This section will discuss the blood lead level and ZPP in detail and will outline their relative advantages and disadvantages. 

Other blood tests currently available to evaluate lead exposure will also be reviewed. The blood lead level is a good index of current or recent lead absorption when there is no anemia present and when the worker has not taken any chelating agents. However, Lead Paint Poisoning In Children blood lead levels along with urinary lead levels do not necessarily indicate the total body burden of lead and are not adequate measures of past exposure. 

One reason for this is that lead has a high affinity for bone and up to 90% of the body's total lead is deposited there. A very important component of the total lead body burden is lead in soft tissue (liver, kidney, and brain). This fraction of the lead body burden, Lead Paint Poisoning In Children the biologically active lead, is not entirely reflected by blood lead levels since it is a function of the dynamics of lead absorption, distribution, deposition in bone and excretion. 

Following discontinuation of exposure to lead, the excess body burden is only slowly mobilized from bone and other relatively stable body stores and excreted. Consequently, Lead Paint Poisoning In Children a high blood lead level may only represent recent heavy exposure to lead without a significant total body excess and likewise a low blood lead level does not exclude an elevated total body burden of lead. 

Also due to its correlation with recent exposures, the blood lead level may vary considerably over short time intervals. To minimize laboratory error and erroneous results due to contamination, Lead Paint Poisoning In Children blood specimens must be carefully collected after thorough cleaning of the skin with appropriate methods using lead-free blood containers and analyzed by a reliable laboratory. 

Under the standard, samples must be analyzed in laboratories which are approved by OSHA. Analysis is to be made using atomic absorption spectrophotometry, anodic stripping voltammetry or Lead Paint Poisoning In Children any method which meets the accuracy requirements set forth by the standard. 

The determination of lead in urine is generally considered a less Lead Paint Poisoning In Children reliable monitoring technique than analysis of whole blood primarily due to individual variability in urinary excretion capacity as well as the technical difficulty of obtaining accurate 24-hour urine collections.

In addition, workers with renal insufficiency, whether due to lead or some other cause, Lead Paint Poisoning In Children may have decreased lead clearance and consequently urine lead levels may underestimate the true lead burden. Therefore, urine lead levels should not be used as a routine test. 

The zinc protoporphyrin test, unlike the blood lead determination, measures an adverse metabolic effect of lead and Lead Paint Poisoning In Children as such is a better indicator of lead toxicity than the level of blood lead itself. The level of ZPP reflects lead absorption over the preceding 3 to 4 months, and therefore is a better indicator of lead body burden. 

The ZPP requires more time than the blood lead to read significantly elevated levels; the return to normal after discontinuing lead exposure is also slower. Furthermore, the ZPP testis simpler, faster, and Lead Paint Poisoning In Children less expensive to perform and no contamination is possible. Many investigators believe it is the most reliable means of monitoring chronic lead absorption.

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