A 3-Year-Old Boy Is Brought to the Office for a Routine

A 3-year-old boy is brought to the office for a routine visit.  The patient is doing well, and his parents have no concerns.  Review of systems is unremarkable.  He was recently adopted from China; his medical and family history is unknown.  The patient takes no daily medications and has received all recommended immunizations.  His adoptive parents are schoolteachers, and the family lives in a newly built home.  Vital signs are appropriate for age, and BMI is at the 40th percentile.  Examination shows a quiet and alert boy.  Cardiac, pulmonary, and abdominal examinations are unremarkable.  Complete blood count and serum electrolytes are normal.  Venous lead level is 60 µg/dL (normal: <5) .  X-ray of the abdomen reveals no lead-containing foreign bodies.  Lead toxicity and exposure are discussed with the family.  Which of the following is the best next step in management of this patient?

A) Intravenous calcium disodium edetate (EDTA)
B) Observation and repeat lead testing in 1 month
C) Oral activated charcoal
D) Oral D-penicillamine
E) Oral meso-2,3-dimercaptosuccinic acid (DMSA, succimer)

Correct Answer:

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