Journal
PEDIATRIC EMERGENCY CARE
Volume 26, Issue 5, Pages 370-373Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PEC.0b013e3181db2237
Keywords
lead poisoning; plumbism; encephalopathy; anemia; toxicity; autism
Categories
Funding
- National Institutes of Health [K12HL087164]
- Agency for Toxic Substances and Disease
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Acute encephalopathy from childhood lead poisoning is fortunately rare. However, in pediatric patients with developmental disabilities and pica, there is a risk of lead exposure at a dose commensurate with encephalopathy, coupled with a risk of delayed diagnosis because of difficulty in distinguishing between baseline and altered behavior. We report here a 4-year old autistic boy who presented to the pediatrician's office with gastrointestinal symptoms and behavioral changes and was at first thought to have a viral syndrome. He returned 2 days later with a worsening illness; increasing pallor, vomiting, abdominal colic, and changes in consciousness were recognized in the emergency department as lead-induced anemia and encephalopathy, associated with a positive abdominal film for paint chips and a blood lead level equal to 216 mu g/dL (10.43 mu mol/L) (reference, <10 mu g/dL or 0.483 mu mol/L). As this case illustrates, prompt recognition is dependent on the skills and suspicions of an astute clinician, especially in the busy emergency department.
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