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April 25, 1990

Treatment of Lead Poisoning

JAMA. 1990;263(16):2181-2182. doi:10.1001/jama.1990.03440160043032

To the Editor.—  The article by Dr Rempel1 addresses important concerns with regard to the diagnosis, surveillance, and management of lead poisoning in adults. However, no references are given for the explanation of the edetate disodium calcium lead-mobilization test, and this explanation appears to set new alternative criteria for reaching the conclusion that the lead-mobilization test indicates a high body burden. Dr Rempel must explain further the basis for and the utility of the statement that "the lead-mobilization test indicates a high body burden of lead if the urine level doubles." Does the author mean that a rise from 0.05 μmol/d to 0.10 μmol/d (to convert to micrograms per 24 hours, multiply by 207.21) is a positive test result? This would lead to an erroneous conclusion. Both lead excretions are within the normal limits and, in fact, the difference between the 0.05-μmol/d and the 0.10-μmol/d level may well