A 3-year-old Caucasian boy is brought to your office by his mother with complaints of irritability and decreased appetite. The mother says that the boy seems weak and has been less active over the last several weeks. The patient regularly spends some time outside the house under the supervision of his older brother, and the brother saw him eating cement and woodwork several times. The patient's past medical history is insignificant. He has no known allergies. All his vaccinations are up-to-date. He received iron and vitamin D supplements. His vital signs are stable. Physical examination reveals a non-distended abdomen with periumbilical tenderness. What is the best next step in the management of this patient?

Question

A 3-year-old Caucasian boy is brought to your office by his mother with complaints of irritability and decreased appetite.  The mother says that the boy seems weak and has been less active over the last several weeks.  The patient regularly spends some time outside the house under the supervision of his older brother, and the brother saw him eating cement and woodwork several times.  The patient's past medical history is insignificant.  He has no known allergies.  All his vaccinations are up-to-date.  He received iron and vitamin D supplements.  His vital signs are stable.  Physical examination reveals a non-distended abdomen with periumbilical tenderness.  What is the best next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: Although the lead concentration in the environment has been decreased recently, it still remains a significant environmental hazard. Children are especially susceptible because of their typical 'hand-mouth' behavior. The prompt recognition of lead poisoning is very important because some complications (mainly neurological and neurocognitive) can be irreversible. Many patients present with non-specific symptoms such as anorexia, decreased activity, irritability, vague abdominal pain and insomnia; therefore, careful history taking (living conditions, potential environmental exposures, and 'hand-mouth' behavior) and a high degree of suspicion are important for early diagnosis. The initial laboratory evaluation in patients with suspected lead poisoning should include CBC, serum iron and ferritin levels, and reticulocyte count. These tests will help detect the presence of anemia and iron deficiency. Measuring blood lead levels is crucial for the development of the treatment plan. (Choices C and A)In patients who require chelation therapy, a basic metabolic profile and urinalysis should be performed. (Choice D)Abdominal radiographs may be indicated in patients with a history of acute ingestion of lead containing products (e.g., fishing weights). Educational Objective: The initial laboratory evaluation in patients with suspected lead poisoning should include CBC, serum iron and ferritin levels, and reticulocyte count. These tests will help detect the presence of anemia and iron deficiency.

A 3-Year-Old Caucasian Boy Is Brought to Your Office by His