In reference to Catherine Watson Genna's comments on Lead toxicity.  I spoke
with my colleague Dr. Shu Shum,  who is a "brilliant" clinical toxicologist
pediatrician,  and great buddy of mine about lead chelation,  particularly
with reference to treatment with Iron(we'd never heard of it).

        1)  Lead poisoning is never treated with Iron.  Rather,  iron
deficiency is common in these patients,  and Iron is used to supplement the
patient's iron deficiency,  not to treat the lead poisoning.

        2)  For lead poisoning,  we currently used Succimer(Chemet)
generally given three times daily ORALLY.  It is very safe and super
efficient at removing lead.  Remember that lead is primarily stored in bony
tissues,  and may take replicate treatments at monthly intervals to remove
all of the body stores.  The general method is to treat for about 7 days.
Wait about a month,  remeasure the lead level.  Continue to treat at monthly
intervals until the lead level reaches about 10 ug/deciliter.   Also,  have
the home environment tested for lead dust, etc.

`       3)  Many screening programs use the finger stick to collect the
blood for measuring.  My laboratories use this method too.  However, one
thing I've noted,  is environmental contamination(such as from a pencil)
can dramatically  alter this test.  Everytime I get a kid with 45 or more
lead,  we order a pheblotomy and  remeasure the lead,  and invariably,  the
lead level is normal.  What i'm saying is ,  never depend on a finger stick
for a definitive lead level,  instead draw a venous blood sample.

        4)  True lead levels of 45 are potentially hazardous,  and must be
chelated so as to drop the level to the 10 range,  there is no discussion
about this.  The possibility of mental retardation is strongly correlated
with lead levels > 25( and maybe even > 10).

        5)  Because the lead was obviously derived from sanding and whatever
took place in the home,  I think it is advisable to draw a blood lead on mom
as well.  She may require chelation as well,  and could possible be the
source of the lead in her infant(a strong maybe).  Its good to be safe and
thorough.

        6) In a young infant,  the long term sequelae of high lead levels
should probably be minimal,   if sufficient chelation is undertaken.





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T.W. Hale, Ph.D.
Associate Professor of Pediatrics
Texas Tech University School of Medicine

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