带领|概述
带领exposures continue to be a concern in many areas of the United States and the world. Lead in the body of a child can lead to learning, memory, attention and behavioral problems, decreased IQ, anemia, and stomach problems. Taking steps to reduce your contact with lead can greatly improve health outcomes for your family.
铅的来源
铅暴露的最常见来源是来自土壤，水和铅漆。在1978年之前建造的美国的房屋更有可能包含铅危害。您可以查找马萨诸塞州房屋的检查历史Mass.gov's Lead Safe Homes Search.
铅的其他来源包括传统和民间药物；进口陶器，珠宝，香料和化妆品；钓鱼者；子弹古董；和更多。
神话破裂
带领exposure is:
- NOT a problem of the past. It is estimated that over 500,000 children in the United States have raised blood lead levels.
- 不仅是吃铅基油漆芯片。土壤，管道，香料等也可以是铅的来源。
- NOT risk-free. There are no safe blood lead levels. Adverse affects in both children and adults are associated with increasing levels of lead.
Learn more
State-specific information about lead can be found on state department of public health websites.
- Connecticut:康涅狄格州铅中毒预防和控制计划网站athttps://portal.ct.gov/DPH/Environmental-Health/Lead-Poisoning-Prevention-and-Control/Lead-Poisoning-Prevention-and-Control-Program
- Maine:Maine Division of Environmental and Community Health websiteathttps://www.maine.gov/dhhs/mecdc/environmental-health/eohp/lead/index.shtml
- Massachusetts:Massachusetts Childhood Lead Poisoning Prevention Program websiteathttps://www.mass.gov/lead-and-your-childs-health
- Rhode Island:Rhode Island Center for Healthy Homes and Environment websiteathttps://health.ri.gov/healthrisks/poisoning/lead/
- Vermont:佛蒙特州公共卫生跟踪网站athttps://www.healthvermont.gov/tracking/childhood-lead-poisoning
Reducing lead exposures
Reducing your child's exposure to lead and lead-based products is one of the most important things you can do to prevent health problems associated with elevated blood lead levels. Below are some first steps you can take to reduce your child's lead exposures. However, the information below does not address all the possible sources of lead exposure.
6种减少铅暴露的技巧
- Childhood Lead Exposures: 6 Actions to Reduce Your Family's Risks (English)
- Exposição de Crianças ao Chumbo:6açõesParareduzir os riscos na suafamília（葡萄牙）
- Exposicióndelosniñosal plomo：6 Acciones Para Reducir los Riesgos de Su Familia (Spanish)
Safer Gardening:Reducing Lead Exposures from Soil (English)
For more resources, in many languages, on childhood lead exposures go to the Massachusetts Department of Public Health Childhood Lead Poisoning Prevention Program (CLPPP) website athttps://www.mass.gov/lists/lead-brochures-and-fact-neets.
EP level and lead
EP level stands for erythrocyte protoporphyrin. Another term that is commonly used is zinc protoporphyrin or ZPP. In the past, this test was also known as a free erythrocyte protoporphyrin (FEP).
EP是每个人都在创建新的红细胞（红细胞中携带氧气）的化学物质。在铅水平高的儿童中，EP升高，因为铅会干扰红细胞的产生。每当您的孩子都有铅水平时，都会在血液中测量该化学物质（红细胞原磷脂或EP）进行筛查。
EP有助于确定孩子系统中的铅是否对我们可以测量的身体产生任何影响。EP是寻找铅对孩子的唯一方法之一。通过查看EP，我们可以更好地了解体内有多少铅。考虑EP的另一种方法是：由于EP是在人体组织中制造的，如果EP升高，它表明其他身体组织（例如肾脏或大脑）也受到铅的影响。
EP有时也可以用于确定孩子暴露于铅的时间。它还可以确定孩子是否仍在暴露于铅中；当孩子再次接触铅时，EP将会上升。最后，EP帮助医生管理孩子的铅中毒。由于治疗铅中毒（例如，螯合），EP降至正常范围。
The normal range for ZPP is zero to 35.
Iron deficiency can also raise your child's EP. So, if your child is anemic he/she may have an elevated EP from anemia and not from lead poisoning. Still, the EP is very useful for a few reasons. First, even though iron deficiency and lead poisoning both raise EP, you can usually tell which of these is responsible. Second, if an EP is elevated because the child has iron deficiency, the doctor can immediately start giving iron supplements to correct the deficiency.
铅螯合药物
Two common lead chelation medications are penicillamine and DMSA/CHEMET.
D penicillamine
Penicillamine is a drug that binds with lead in the body and increases its removal in the urine. Its brand name is Cuprimine. Penicillamine will get the lead out of the body, but it sometimes takes several months to do so.
Penicillamine is available as a capsule or tablet. The capsule can be opened and sprinkled on food, or mixed into a small amount of liquid. The tablet may be crushed with a spoon. Capsules are available in 125 mg or 250 mg strength. Tablets are 250 mg, but they are scored so they can be broken in half or quartered.
可以用果汁，苹果酱，巧克力糖浆，Zarex（果汁浓缩液），果冻或非乳制品奶油给予。应该在空腹（饭后30分钟或两个小时之前）给予它。然而，几个孩子可能会抱怨食物不适，他们可能需要一些饼干或小吃。
是非常重要的,你的孩子接收of the doses of penicillamine that the doctor has ordered. Because of the potential adverse effects of penicillamine, it is also important that your child returns to the Lead Clinic for all of his/her scheduled visits. When you child begins penicillamine, it is essential for us to see him/her in the Lead Clinic two weeks after starting treatment. After two weeks on the medication, if all is going well, we can space the visits out to once a month.
您的孩子可能需要服用青霉素长达三到四个月。
铁治疗不应在同一蒂姆e as penicillamine, and penicillamine should not be given with milk or milk products. You can give penicillamine two hours before or two hours after any iron or calcium product.
Your doctor will have discussed the possible but unlikely side effects of penicillamine with you. Pharmacy information and medication labelling give side effects for penicillamine when it is used in adults for other illnesses. The risk of side effects when penicillamine is given to children is extremely low and completely different than the risks for the adult.
These side effects include allergy to the drug (5 to 7 percent risk), which may cause a skin rash, a decrease in the number of white blood cells and/or platelets (risk is less than 1 percent). The rash of penicillamine consists of red, raised bumps on the face and/or trunk. These side effects will go away when the medication is stopped.
当儿童服用青霉素时，尿液中会出现强烈的药物气味。这是可以预料的，这不是问题。由于我们正在寻找孩子的血液和尿液的任何变化，因此我们将在每次访问时要求进行血液检查和尿液样本。
DMSA/CHEMET
DMSA, also known as Chemet and Succimer, is a drug that binds with the lead in the body and increases its removal in the urine.
DMSA comes in capsules only. The capsule can be opened and sprinkled on food if your child is unable to swallow pills.
The medicine has a bad smell and taste. It will be better tolerated by your child if it is mixed with something sweet tasting such as chocolate syrup, ice cream, pudding, or jellies. The capsule can be mixed with food five to 10 minutes before administering so that some of the smell will evaporate.
DMSA是根据您孩子的体重给药的，并由您的医生在指定的时间内给予。重要的是，您的孩子要收到医生订购的所有DMSA剂量，否则药物将无法正常工作。同样重要的是，您的孩子要回到所有预定的访问中返回领导诊所，以便我们可以监视他/她的任何可能的副作用。您的孩子可能需要在几周内需要第二次甚至第三次DMSA课程。
DMSA may cause some temporary elevations in your child's liver enzymes. We will draw blood work at each clinic visit both to monitor his/her lead levels and to look for any possible adverse effects. DMSA may also cause a skin rash, however, this is rare.
如果您的孩子在服用DMSA时会出现皮疹，或者您还有其他疑问或疑虑，请在星期一，星期三或周五致电Lead Clinic与护士交谈。您还可以打电话给您的主要诊所医生或毒理学研究员。
Either person can be reached by calling the page operator at 617-355-6369. Nora Llach, RN, MPH, Boston Children's Hospital