Action
- Clinical suspicion of lead poisoning
- Draw venous blood lead level (BLL)
Decision
What is the blood lead level (BLL)?
Background
The history is particularly critical, since many patients will be asymptomatic or present with nonspecific symptoms and may not be aware of a history of lead exposure unless asked. Several case reports highlight situations in which the patient was initially misdiagnosed because the treating clinician failed to consider lead poisoning in the differential diagnosis. Consider a diagnosis of lead poisoning for any patient who presents with unexplained gastrointestinal symptoms, such as constipation, abdominal pain (which is usually severe and episodic), vomiting, anorexia, weight loss, or for a patient who has persistent unexplained neurologic symptoms such as headaches, confusion, fatigue, somnolence, inability to concentrate, irritability, or hyperactivity. Anemia or hypertension of unknown etiology should also raise suspicion for lead poisoning. Symptoms such as irritability, aggressiveness, agitation, lack of focus and attention, clumsiness, decreased activity, or somnolence are concerning for encephalopathy. Patients should be asked about the onset and duration of each symptom. A patient presenting with these premonitory symptoms can rapidly progress to a state of stupor or seizures.
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