Senior House Officer A+E clerking:

Date: 19/10/09, 16:30
Age: 4 years 8 months
Sex: Male
Ethnicity: West Indian

Presenting Complaint: ? Lead intoxication

History of Presenting Complaint: The child is thought to have licked lead containing paint from a toy car, leading to lead intoxication.

the child has been exhibiting symptoms of irritability, headaches, abdominal pain and seizures since his last admission.

- Admitted at 2 years 5 months old presenting with mental retardation and discharged. ?lead poisoning. Initial blood lead result unknown.

- Admitted at 2 years 8 months presenting with symptoms of lead intoxication. Blood lead increased to 79ug/100ml
Patient has exhibited signs of pica from a young age.

Past Medical History: nil of note- normal antenatal, birth and developmental history

Drug History: nil

Allergies: no known drug allergies

Family History: only child, nil relevant family history

Social History: not yet in formal education

On Examination: observations stable, apyrexial.

lungs clear, heart sounds I, II, 0 added sounds, mild abdominal tenderness on palpation, bowel sounds present, no organomegaly, no focal neurological signs, pupils equal and reactive to light. Mild developmental retardation, exibiting signs of pica by attempting to eat plaster from the hospital walls.

Differential Diagnosis: psychological stress, cuturally related behaviour, malnutrition, developmental brain disorder

Plan: blood tests, abdominal X-ray, full psychologial assessment, screening of family and home environment, ?MRI scan, ?chelation therapy ?inform social services.