Summary
Definition
History and exam
Key diagnostic factors
- family history of lead poisoning or parental work with lead
- cognitive impairment (children)
- behavioral changes (children)
- headaches (children)
- clumsiness and agitation (children)
- loss of appetite (children)
- constipation (children)
- somnolence (children)
- altered mental state
- cerebellar signs
- seizures
- coma
Other diagnostic factors
- colicky abdominal pain (adults)
- hypertension (adults)
Risk factors
- age 9 to 36 months
- housing with lead hazards
- occupational lead exposure
- lead-contaminated water supplies
- low socioeconomic status
- hobbies working with lead
- pica
- use of folk medications
- fetal exposure
- mineral-deficient and high-fat diets
- bullet firing ranges
Diagnostic tests
1st tests to order
- whole-blood lead level
- complete blood count
- serum ferritin
Tests to avoid
- post-chelator challenge urinary metal testing
- hair or nail testing
- heavy metal screening test
Tests to consider
- 24-hour urine lead with chelation
- abdominal radiographs
- nerve conduction studies
Treatment algorithm
all patients
Contributors
Authors
J. Routt Reigart, MD
Professor Emeritus of Pediatrics
Medical University of South Carolina
Charleston
SC
Disclosures
JRR declares that he has no competing interests.
Peer reviewers
Howard Hu, MD, MPH, ScD
NSF International Chair
Department of Environmental Health Sciences
Professor of Environmental Health Sciences, Epidemiology and Internal Medicine
University of Michigan Schools of Public Health and Medicine
Ann Arbor
MI
Disclosures
HH is an author of a reference cited in this topic. HH has received research funding greater than 6 figures USD.
Rose H. Goldman, MD, MPH
Chief
Occupational & Environmental Medicine
Cambridge Health Alliance
Associate Professor of Medicine
Harvard Medical School
Associate Professor of Environmental Health Sciences
Harvard School of Public Health
Boston
MA
Disclosures
None disclosed.
Alison Jones, MD, FRCPE, FiBIOL, FRCP, FRACP
Dean
School of Medicine
Campbelltown Campus
University of Western Sydney
Australia
Disclosures
AJ declares that she has no competing interests.
References
Key articles
Centers for Disease Control and Prevention (CDC). Understanding blood lead levels. Adult Blood Lead Epidemiology and Surveillance (ABLES). National Institute for Occupational Safety and Health (NIOSH) workplace safety & health topics. Apr 2023 [internet publication].Full text
Centers for Disease Control and Prevention (CDC). Blood lead levels: United States, 1988-1991. MMWR Morb Mortal Wkly Rep. 1994;43:545-548.Full text Abstract
Harvey B, ed. Managing elevated blood lead levels among young children: recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. Atlanta, GA: CDC; 2002.Full text
Centers for Disease Control and Prevention (CDC). Adult blood lead epidemiology and surveillance - United States, 2008-2009. MMWR Morb Mortal Wkly Rep. 2011 Jul 1;60(25):841-5.Full text Abstract
Mahaffey KR. Nutrition and lead: strategies for public health. Environ Health Perspect. 1995;103(suppl 6):191S-196S.Full text Abstract
Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Household interventions for secondary prevention of domestic lead exposure in children. Cochrane Database Syst Rev. 2020 Oct 6;10:CD006047.Full text Abstract
Yeoh B, Woolfenden S, Lanphear B, et al. Household interventions for preventing domestic lead exposure in children. Cochrane Database Syst Rev. 2014;(12):CD006047.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Iron deficiency anemia
- Non-lead peripheral neuropathy
- Arsenic poisoning
More DifferentialsGuidelines
- Childhood lead poisoning prevention
- WHO guideline for clinical management of exposure to lead
More Guidelines
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