Pediatrics CK

2 months

2 months

2 months

2 months

5 months

4-5 months

4-5 months

4-5 months

6 months

6 months

6 months

6 months

9 - 10 months

9 - 10 months

9-10 months

9-10 months

11 months

12 months

12 months

12 months

12 months

12 months

15 months

15 months

15 months

15 months

18 months

18 months

18 months

18 months

18 months

2 years

2 years

2 years

2 years

2 years

2 years

3 years

3 years

3 years

3 years

3 years

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3 years

4 years

4 years

4 years

4 years

4 years

5 years

5 years

5 years

5 years

5 years

5 years

5 years

5 years

harsh holosystolic murmur
most close spontaneously
Surgery for symptomatic, children < 1 w/ pulmonary hypertension

fixed splitting of S2,
often with right ventricular hypertrophy from L to R shunt
CXR: cardiomegaly and increased pulmonary vascular markings
Tx: most close spontaneously

continuous "machinery" murmur, loud s2, bouding peripheral pulses

Tx give indomethacin to close PDA unless needed for survival; surgery if indomethacin fails

Tetralogy of Fallot
Transposition of the great Vessels
Hypoplastic Left Heart

asymptomatic hypertension with BP higher in upper extremities; difference in BP between left and right arm

Tx: open w/ PGE1

cyanosis immediately after birth. Single loud S2.
CXR w/ absence of main pulmonary artery, and increased pulmonary vascular markings.

Tx: 1. IV PGE1 to open PDA
2. Surgery

Pulmonary Stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect

Most common cyanotic congenital heart disease in children. Seen w/ Tet spells

Tx:
1. PGE1
2. Temporary palliation w/ shunt before surgical correction

B-cell deficiency only in boys

1. low quantitative Immunoglobulin levels
2. absent B cells, high T cells

Tx: IVIG and prophylactic antibiotics

Immunoglobulin level drops in 20s and 30s; usually a combined B and T cell defect

Increased pyogenic uper and lower respiratory infections

Tx: IVIG

Mild, may develop recurrent respiratory or GI infections

Do NOT give immunoglobulins

Increased infections with fungi and P. jiroveci

Tx: bone marrow transplantation and IVIG for antibody deficiency; PCP prophylaxis

DNA repair defect

Oculocutaneous telangiectasias
Cerebellar ataxias
Increased risk of skin cancers

No specific Treatment

Adenosine Deaminase Deficiency

Lacks T and B cells.
frequent bacterial infections; chronic candidiasis,

Tx: bone marow or stem cell transplant, and IVIG
Needs PCP prophylaxis

X-linked disorder w/ less severe T and B cell dysfunction

Eczema, increased IgE and IgA, decreased IgM, thrombocytopenia

Increased risk of atopic disorders


Tx is IVIG and abx

deficient superoxide production by PMN's and macrophages

Dx: nitroblue tetrazolium test
Tx: daily TMP-SMX

A defect in chemotaxis of leukocytes
Recurrent skin, mucosal, and pulmonary infections

Delayed separation of umbilical cord

Increased incidence of S. pyogenes, S. aureus, and Pseudomonas

Tx: Bone marrow transplant

Defect in neutrophil chemotaxis/microtubule polymerization

Blond, light colored
Increased incidence of infections w/ S. pyogenes, S. aureus, and Pseudomonas.

Tx: Bone marrow transplant

bleeding disorders
mongolion spots (burises)
osteogenesis imperfecta (fractures)
bullous impetigo (cigarette burns)
coining (alternative tx in certain cultures)

1. skeletal survey / bone scan - various stages of healing
2. test: gonorrhea, syphilis, chlamydia, HIV if sexual abuse
3. Shaken baby syndrome - retinal hemorrhages, CT contrast for subdral

1. document
2. notify CPS
3. hospitalize

most common congenital heart defect
harsh holocystolic infectionn
narrow s2 w/ increased p1
mid-diastolic apical rumble reflecting increase flow across mitral valve

echocardiogram

most resolve spotaneously

surgical repair for children < 1 yo pulmonary hypertension, and older children w/ large VSDs that have not decreased in size over time

wide and fixed split s2
systolic ejection murmur at upper left sternal border (from increased flow across pulmonic valve)

echocardiogram
cxr: cardiomegaly and increased pulmonary markings

most close spontaneously

surgery if infants w/ CHF and patients w/ mroe than a 2:1 ratio of pulmonary to systemic flow

risk factor: maternal rubella, prematurity, female

continuous machinery murmur at sternal border

color flow doppler from aorta to pulmonary artery

indomethacin unless pda needed for survival

surgery if indomethacin fails or child > 6-8 months of age

transposition of great vessels
tetralogy of fallot
hypoplastic left heart

asymptomatic hypertension, low extremity claudication, syncope, epistaxis, and headache

echocardiography
cxr: 3 sign, rib notching

1 pge1 to keep open
2. surgery

most common cyanotic congenital heart lesion in newborns

risk factors: diabetic mothers, DiGeorge syndrome

cyanosis an dcritical illness immediately after birth

single loud s2

1. echocardiography
2. cxr: narrow heart base, egg-shaped silhouette

1. IV PGE1 to maintain or open the PDA
2. surgery not feasible within first few days of life, or if PDA can't be maintained w/ prostaglandin, perform balloon atrial septostomy to create an enlarged ASD
3. Surgical correction

pulmonary stenosis
right ventricular hypertrophy
overriding aorta
ventricular septal defect

cyanosis often not present at birth, but develops over first two years of life; degree of cyanosis reflexts extent of pulmonary stenosis

children oftten squat for relief (increase SVR) during hypoxemic episodes (tet spells)

systolic ejection murmur at L upper sternal border

1. echocadiography and catheterization
2. cxr: boot shaped heart w/ decreased pulmonary vascular markings
3. ecg: right axis deviation due to righ ventricular hypertrophy

1. pge1 to keep pda open
2. treat hypercyanotic tet spells w/ oxygen, propanolol, phenylephrine, knee-chest position, fluids, morphine
3. temporary palliation through creation of artificial shunt (e.g., balloon atrial septostomy) before definitive surgical correction (Blalock-Taussig) shunt

1. thelarche - breast bud development
2. pubarche - pubic hair development
3. growth spurt
4. menarche - first menstrual period; average 12.5 years

1. gonadarche - testicular enlargement
2. pubarche
3. adrenarche - axillary hair, facial hair, vocal changes

no testicular enlargement in boys by age 14

no breast development or pubic hair in girls by age 13

trisomy 21 (most common) or robertsonian translocation (higher risk of recurrence)

mental retardation, flat facial profile, epicanthal folds, simian crease

associated w/ duodenal atresia, Hirschsprung's disease, and gongenital heart disease (ASD, VSD, endocardial cushing defects)

associated w/ ALL, hypothyroidism and early-onset Alzheimer's

Trisomy 18

Rocker bottom feet
micrognathia
low set ears
congenital heart disease
horseshoe kidneys

Trisomy 13

polydactyly
microphthalmia
microcephaly
holoprosoncephaly

45 xxy

inactivated x chromosome (Barr body)
one of the most common causes of hypogonadism in males
testicular atrophy, tall stature, long extremities, gynecomastia

Tx: testosterone

45XO

gonadyl dysgenesis
no barr body
short stature, shield chest, widely spaced nipples, webbed neck, coarctation of aorta, lymphedema of hands and feet, horseshoe kidneys

47 xyy

increased frequency among inmates of penal institutions
very tall and severe acne and antisocial behavior

decreased phenylalanine hydroxylase or decreased tetrahydrobiopterin cofactor

tyrosine becomes essential adn phenylalanine builds up excess ketones

mental retardation, fair skin, eczema, musty or mousy urine odor

blond hair, blue eyes, increased risk of heart disease

Tx: decrease phenylalanine and increase tyrosine in diet

X-linked efect in FMR1 gene, triplet repeat disorder

second most common cause of mental retardation

macro-orchidism, long face w/ large jaw, large, everted ears, autism

autosomal recessive disorder in CFTR gene on Chr 7

failure to thrive, chronic sinopulmonary disease

recurrent pulmonary infections, meconium ileus, at risk for fat soluble vitamin deficiency

Sweat chloride test > 60 mEq/L if less than 20 years old

> 80 mEq/L in adults

x-linked recessive
deficiency of alpha-galactosidase A

accumulation of ceramide trihexoside in heart, brain, and kidneys

renal failure, increased risk of stroke and MI

autosomal recessive

absence of galactosylceramide and galactoside

accumulation of galactocerebroside in brain

optic atrophy, spasticity, early death

autosomal recessive

deficiency of glucocerebrosidase

accumulationglucocerebroside in brain, liver, spleen, and bone marrow

hepatosplenomegaly, anemia, and thrombocytopenia
"crinkled paper" enlarged cytoplasm

type 1 is more common and compatible w/ normal life span and does not affect brain

autosomal recessive

Nieman Pick PICKS his SPHINGER

deficiency of sphingomyelinase leads to buildup of sphingomyelin cholesterol in reticuloendothelial and parenchymal cells and tissue

Patients die by age of three

Tay SaX lack heXosaminidase

absence of hexosaminidase leads to accumulation of GM2 ganglioside

Infants noraml until 3-6 months of age, then weakness begins and development slows and regresses

cherry-red spot on macula

death by 3

autosomal recessive

deficiency of arylsulfatase A leads to accumulation of sulfatide in brain, kidney, liver, and peripheral nerves

autosomal recessive

deficiency of alpha L idurinidase

corneal clouding and mental retardation

x-linked recessive

deficiency of iduronidase sulfatase

milder form of no corneal clouding and mild mental retardation

Hunters need to see (no corneal clouding) to aim for X

1. Pulmonary: chest physical therapy, bronchodilators, steroids, antibiotics, DNase
2. pancreatic enzymes, fat soluble vitamins for malabsorption
3. maintain high calorie highprotein diet
4. if disease severe but can tolerate surgery, can try for lung or pancreas transplants

abrupt onset, colicky pain in healthy children, often accompanied by flexed knees and vomiting

triad: abdominal pain, vomiting, blood per rectum

currant jelly stools, lethargy, fever, sausage shaped RUQ mass

Associated w/ Meckel's diverticulum, intestinal lymphoma (> 6 yo), Henoch-Schonlein purpura, parasites, polyps, adenovirus or rotavirus infection, celiac disease, CF

1. correct volume or electrolyte abnormalities
2. w/ high suspicion, air contrast barium enema performed WITHOUT DELAY (both diagnostic and therapeutic)

surgical reduction and resection if peritoneal signs

hypochloremic hypokalemic metabolic acidosis

nonbilious projectile emesis, olive shaped mass

abdominal ultrasound imaging of choice

1. correct dehydration and acid-base electrolyte abnormalities
2. surgical correction w/ pyloromyotomy

failure of omphalomesenteric (or vitelline) duct to obliterate

Rule of 2's
under 2 yo common
2x in males
2 types of tissue (pancreatic and gastric)
2 inches long
within 2 ft of ileocecal valve
2% of population

painless rectal bleeding

mecek scintigraphy scan (technetium-99m pertechnate) is diagnostic

excision of diverticulum with adjacent ileal segments

lack of ganglion cells in distal colon

neonate failure to pass meconium within 48 hrs of birth,
abdominal disension and explosive discharge of stool following rectal exam

imaging study of choice: barium enema
Definitive diagnosis: full-thickness rectal biopsy

two stage surgical repair
1. diverting colostomy at time of dx
2. definitive pull thru procedure connecting remaining colon to rectum (several weeks later)

abnormal positioning of small intestine and formation of fibrous bands (Ladd's bands)

newborn w/ bilious emesis, abdominal pain, distension, and passage of blood or mucus in stool

study of choice: upper GI - shows abnormal location of ligament of Tretiz

1. NG tube for decompression
2. IV fluid hydration
3. surgical repair (emergent when volvulus present)

common in premature infants

delayed gastric emptying, abdominal distension, rapidly progress to perforation, peritonitis

hyponatremic metabolic acidosis

radiographics may show dilated loops, pneumatosis intestinalis

1. NPO, orograstic tube, correct electrolyte abnormalities, TPN and IV antibiotics
2. surgery: perforation

B cell deficiency in boys only

life threatening: encapsulated organisms

quantitative immunoglobulin levels

if low, confirm w/ subsets
absent b cells, t cells often high

absent tonsils and lymphoid another clue

prophylactic abx and IVIG

immunoglobulins drop in 20s and 30s

usually a combined B and T cell defect

increased pyogenic upper and lower infections; increased risk of lymphoma nd autoimmune disease

quantitative immunoglobulin levels

confirm w/ b and t cell subsets

IVIG

mild, most common immunodeficiency

usually asymptomatic, may develop recurrent respiratory and GI symptoms

common presentation is anaphylactic transfusion reaction due to anti-IgA antibodies

quantitative IgA levels

treat ifnections

do NOT give immunoglobulins -- anaphylaxis with antibody development

tetany secondary to hypocalcemia
think DiGeorge

high risk of fungi an dPCP infections

absolute lymphocytic count
mitogen stimulation response
delayed hypersensitivity skin testing

bone marrow transplantation and IVIG for antibody deficiency

pcp prophlyaxis

alternative:thymus transplant

oculocutaneous telangiectaisas, cerebellar ataxia,hyperpigmentatin an dincreased risk of melanoma due to DNA repair defect

increased incidence of non-Hodgkin's lymphoma, leukemia, and gastric carcinoma

no specific treatment
may require IVIG depending on severity of Ig deficiency

severe lack of B and T cells
adenosine deaminase deficiency

severe frequent bacterial infections, chronic candidiasis and opportunistic infections

bone marrow transplant or stem cell transplant and IVIG

Needs PCP prophylaxis

X linked; less severe B cell and T cell dysfxn

eczema, thrombocytopenia, increased IgE and IgA, decreased IgM

bleeding eczema, recurrent otitis media

increased risk of lymphoma/leukemias, infections from encapslated organisms, atopic disorders

supportive w/ IVIG and abx

rarely survive to adulthood

X linked or autosomal recessive

deficient superoxide production by PMNs and macrophages

Anemia, lymphadenopathy, hyepergammaglobulinemia

Chronic skin, pulmonary, GI, and UTI's, osteomyelitis and hepatitis

Infected organisms catalase +,

Diagnostic: nitroblue tetrazolium test

Treat w/ daily TMP-SMX

defect in chemotaxis of leukocytes

delayed separation of umbilical cord

recurrent skin, mucosal, and pulmonary infections

No pus w/ minimal inflammation in wounds

Bone marrow transplant is curative

autosomal recessive

defectin neutrophil chemotaxis/microtubule polymerization

oculocutaneous albinism, neuropathy, neutropenia

increased incidence of overwhelming infections w/ S. pyogenes, S. aureus, and Pseudomonas

giant granules in neutrophils

Bone marrow transplant

autosomal dominant
hereditary angioedema provoked by stress/trauma

can lead to life-threatening airway edema

Tx: Purified C1 esterase and FFP can beu sed prior to surgery

Inability to form membrane attack complex

recurrent meningococcal or gonococcal infections

Tx: Get appropriate meingococcal vaccine and appropriate antibiotics

CRASH and BURN
Conjnctivitis
Rash
Adenopathy
Strawberry tongue
Hands and feet swollen and red
BURN fever for several days

High dose aspirin to prevent aneurysms
IVIG for inflammation and fever

morning stiffness, gradual loss of motion for at least 6 weeks in patient < 16 yo

1. polyarticular, usually ANA+ and RF - , uveitis common

2. Polyarthritis ANA +

3. Still's dz (systemic onset) - presents w/ fever, hepatomegaly, and salmon colored macular rash; usually RF - and ANA -

1. NSAIDs and strengthening exercises
2. steroids

commonly S. pneumo, H. influenza and M. catarrhalis

otoscopic exam: erythematous tympanic membrane w/ decreased motility

High dose amoxicillin x 10 days

RSV in fall/winter months

clinical diagnosis

CXR if need to r/o pneumonia
Nasopharyngeal PCR confirmatory, but doesn't affect management

1. Supportive
2. Hospitalize w/ marked distress, O2 < 92%, toxic appearance, < 3 months old, underlying cardiopulmonary disease

Treat inpatient w/ contact isolation
- hydration
- oxygen
- can try aerosolized albuterol if it helps

Laryngotracheobronchitis
Parainfluenza virus
3 mo to 3 years
barking cough

clinical impression by stridor and barking cough
AP neck film: steeple sign from subglottic narrowing

mild: outpt cool mist therapy and fluids

moderate: supplemental O2, oral and IM steroids, nebulized epinephrine

severe: hospitalie and give nebulized racemic epinephrine

rapidly progressing supraglottic infection of supraglottic structures
3-7 years old
caused by H. influenza

muffled voice, drooling, neck hyperextended and chin protruding (sniffing dog position) and leaning forward in tripod position to maximize airway entry

clinical impression

1. secure airway before definitive diagnosis; do not eamine throat unless anesthesiologist or otolaryngologist present
2. definitive diagnosis: direct fiberoptic visualization of cherry red, swollen, epiglottitis and arytenoids

3. lateral x ray: thumb-print sign

keep patient calm, call anesthesia, transfer to OR

treat w/ endotracheal intubation or tracheostomy, and IV ceftriaxone or cefuroxime

6 mo - 6 yo

muffled hot potato voice, trismus,drooling cervical lympadenopathy

caused by group A strep, S. aureus, bacterioides

Prefers supine w/ neck extended

lateral neck x-ray: soft tissue plane under 50% of width

aspiration or I&D of abscess

abx

> 10 years age

muffled hot ptoato voice, trismus, drooling

group A strep, S. aureus, S. pneumonia; anaerobes

clinical

I&D +/- tonsillectomy; antibiotics

1. Head CT to rule out increased ICP
2. LP: cell count, gram stain, and culture

Empiric abx (ceftraixone, vacomycin, ampicillin) until bacterial meningitis ruled out

Neonates: ampicillin, cefotaxime, gentamicin

If concern for herpes encephalitis, then acyclovir

Bordatella pertussis - gram negative bacillus
Whooping cough

inspiratory whooop and post0tussive emesis

classic presentation is infant < 6 mo age w/ post-tussive emesis and apnea

elevated WBC
gold standard: culture

hospitalize patients < 6 mo age

erythromycin x 4 days to patients and close contacts

should not return to school/day care until five days after abx administered or three weeks have elapsed in no treatment initiated

Fifth disease
Parvovirus B19

Slapped erythematous cheecks
rash starts on arms and spreads to trunk and legs

rash worsens w/ fever an dsun exposure

can get arthritis, hemolytic anemia and aplastic crisis

Paramyxovirus

Cough, Coryza (head cold), Conjunctivits

Koplik spots - small red spots w/ central gray specks on buccal mcosa

erythematous rash spreads from head to feet

appears ill, unlike rubella

tender lymphadenopathy

erythematous maculopapular rash that starts on face and spreads distaly

Unlike measles, only low grade fever an ddoes not appear ill

HHV-6 acute onset of fever w/ no other symptoms for 3-4 days

febrile seizures may occur w/ fever

maculopapular rash appears as fever breaks on trunk and spreads to face and extremiities

VZV

mild fever, anorexia, and malaise
generalied pruritic tear drop vesicular periphery; lesions at different stages of healing

VZV

reactivation of varicella infection; w/ pain along affected sensory nerve

pruritic tear drop vesicular rash in dermatomal distribution

Coxsackie A

Prodrome: fever, anorexia, oral pain
Oral ulcers, maculopapular vesicular rash on hands and feet, and sometimes on buttocks

biliary atresia
choledochal cysts
intrahepatic cholestasis
Dubin-Johnson syndrome (black liver)
Rotor syndrome (black urine)
TORCH

physiologic jaundice
hemolysis
breast milk jaundice
GI obstruction leading to increased enterohepatic circulation
Crigler-Najjar
Gilbert

uncojungated hyperbilirubinemia

lethargy, poor feeding,high pitched cry, hypertonicity, seizures

mild elevation: phototherapy
severe elevation > 20 mg/dL: exchange transfusion

not present until 72 hrs after birth

bilirubin increase is less than 5 mg/dL/day

bilirubin peaks at less than 14-15 mg/dL

direct bilirubin is < 10% total

resolves by one week in term infants, two weeks in preterm

first 24 hrs of life
bilirubin increase > 0.5 mg/dL/hr
bilirubin peak >15 mg/dL
direct bilirubin > 10% total

persists beyond one week in term infants and two weeks in preterm

VACTERL
vertebral, anal, cardiac, tracheal, esophagageal, renal limb anomalies

polyhydramnios in utero, increased oral secretions, inability to feed, gagging, aspiration pneumonia, respiratory distress

CXR: Ng tube coiled in esophagus

Confirmation: bronchoscopy

surgery

GI tract segments protrude thru diaphragm into thorax; most thru posterior left (Bochdalek)

respitary distress, sunk abdomen

ultrasound in utero

postnatal: cxr

1. high frequency ventilation or ECMO to manage pulmonary hypertension
2. surgery

herniation of intestine thru abdomianl wall next to umbilicus w/ NO SAC

presentation: polyhydramnios, premature,

two stage surgery

Herniation of abdominal viscera thru wall at umbilicus into sac

presentation: polyhydramnios, often premature, associated w/ other GI and cardiac defects; seen w/ Beckwth-Wiedemann syndrome and trisomies

C-section to prevent sac rupture

If sac intact, postpone surgery until fully resucitated

Keep sac covered/stable w/ petroleum and gauze

Intermittent NG suction to prevent distension

Complete or partial failure of duodenal lumen to recanalize during gestational weeks 8-10

polyhydramnios, bilious emesis within hrs after first feeding; associated w/ Down syndrome

abdominal XR: double bubble

surgery

respiratory failure in preterm infants due to surfactant deficiency

first 48-72 hrs of life, RR > 60/min, progressive hypoxemia, cyanosis, nasal flaring, intercostal retractions, expiratory grunt

1. ABG's, CBC, blood cultures
2. CXR: ground glass apperance, air bronchograms

retained amionitic fluid

prominent perihilar streaking in interlobular fissures

coarse, irregular infiltrates; hyperexpansion and pneumothoraces

non-specific pathy infiltrates; neutropenia, tracheal aspirate, gram stain

1. CPAP
2. Artificial surfactant
3. < 30 weeks at risk for preterm delivery, give corticosteroids
4. > 30 weeks, monitor fetal lung maturity w/ L/S ratio

L/S < 2:1

bronchopulmonary dysplasia

< 15 minute duration, generalized seizure with one seizure in 24 hr period. high fever within hrs is typical

> 15 min or focal seizure, or multiple seizures in 24 hr period

if simple, treat fever

if complex, thorough neuro evaluation

hyperkalemia, hyperphosphatemia, hyperuricemia
hypocalcemia

nontender abdominal mass that may cross midline
may have anemia, failure to thrive, and fever

1. CT: fine needle aspiration of tumor w/ round blue tumor cells in rosette pattern
2. urine VMA and HVA elevated

1. local excision
2. post-surgical chemotherapy and/or radiation

renal tumor associated w/ aniridia and hemihypertrophy

associated w/ Beckwith-Wiedemann syndrome and WAGR (Wilm's, Aniridia, Genitourinary abnormalities, mental Retardation)

1. CBC, BUN, creatinine, UA
2. Abdomianl Ultrasound
3. CT of chest and abdomen to detect metastasis

Chr 11:22
male adolescents
local swelling an dpain, with fever anorexia and fatigue

midshaft of long bones

leukocytosis
elevated ESR
lytic bone lesiosn w/ "onion skin"

1. local excision
2. chemothreapy
3. radiation

Osteoblasts
male adolescents
local pain and swelling
NO FEVER ANOREXIA OR FATIGUE
METAPHYSIS of bone (distal femur, proximal tibia, proximal humerus)

20% metastasis to lungs

increased alkaline phosphatase

Sunburst lytic lesions

Chest CT to r/o pulmonary metastasis

Local excision, chemotherapy

< 38.8 C or < 120 F

baby sleeps on back

Osteoblasts
male adolescents
local pain and swelling
NO FEVER ANOREXIA OR FATIGUE
METAPHYSIS of bone (distal femur, proximal tibia, proximal humerus)

20% metastasis to lungs

increased alkaline phosphatase

Sunburst lytic lesions

Chest CT to r/o pulmonary metastasis

Local excision, chemotherapy

< 38.8 C or < 120 F

baby sleeps on back

rear facing, back of car

when > 1 yo an d> 20 pounds, seats can face forward

6 months

12 mo

retinobalstoma
congenital cataracts
retinopathy of prematurity

severe allergy
encephalopathy within 7 days prior to pertussis invaccination

egg allergy, no MMR or influenza vaccine

immunocompromized, avoid live vaccines (oral polio, varicella, MMR)

pregnant, avoid live vacines EXCEPT MMR and varicella

mild fever
current abx therapy
prematurity

sickle cell dz
splenectomy
immunodeficient

irritability, hyperactivity, apathy, anorexia abdominal pain, vomiting, peripheral neuropathy (foot or wrist drop)

10 ug/dL

remove sources of lead exposure

retest at 1-3 months

chelation w/ inpatient EDTA or outpatient oral succimer (DMSA)

chelation therapy of inpatient EDTA + BAL (IM dimercaprol)