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Deferoxamine
13%
8/61
Methylene blue
5%
3/61
N-acetylcysteine
7%
4/61
Nitrite/thiosulfate
Succimer
61%
37/61
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This young child with signs of gastrointestinal colic and pallor along with basophilic stippling on peripheral blood smear is suffering from lead poisoning, which is treated with succimer as a first-line agent in children. Lead poisoning can affect many different organs, including the nervous system, hematopoietic system, liver, and kidneys. A major risk factor is chipped paint in old homes (painted or built before 1974), which this young patient was likely exposed to in his family’s rented old apartment. Symptoms of lead poisoning are nonspecific and include abdominal colic, interstitial nephritis, CNS abnormalities (lethargy and encephalopathy), and anemia. A peripheral blood smear would reveal basophilic stippling due to the aggregation of residual ribosomes, which is seen in lead poisoning and other causes of sideroblastic anemia. Succimer is used as the first-line chelating agent for treatment of lead poisoning. Figure/Illustration A shows a peripheral blood smear featuring red blood cells with basophilic stippling (arrow). Incorrect Answers: Answer 1: Deferoxamine is used as a treatment for iron overload. Answer 2: Methylene blue is used as a treatment for methemoglobinemia. Answer 3: N-acetylcysteine is used as a treatment for acetaminophen toxicity. Answer 4: Nitrite/thiosulfate is used as a treatment for cyanide poisoning. Bullet Summary: Succimer is used as a first-line treatment agent for lead poisoning in children.
3.8
(4)
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