Occurs after occupational or home exposure to lead. There is no threshold level for toxicity.
Anyone at risk of lead exposure requires screening with regular blood lead measurements. There is no 'normal' level, and interventions are initiated at the first sign of increased exposure.
Causes neurodevelopment dysfunction in children and a range of cardiovascular, renal, neurological, and haematological dysfunctions in adults.
The mainstay of treatment is removal of the source. Chelation therapy is given if blood levels exceed 2.1 micromoles/L (44 micrograms/dL) in a child or 3.4 micromoles/L (70 micrograms/dL) in an adult, or if the patient is symptomatic.
Acute lead encephalopathy is a medical emergency requiring aggressive chelation therapy in an intensive care setting.
Acute symptoms resolve with treatment, but neurological impairments and cardiovascular toxicities are irreversible.
Lead resides in bone for decades after exposure has ceased, and all patients therefore require long-term monitoring.
Lead toxicity is a multisystem disease produced by inhalation or ingestion of lead. It produces neurodevelopmental dysfunction in children and a range of cardiovascular, renal, neurological, and haematological dysfunctions in adults. Any detectable lead level is consistent with exposure to lead, but levels >0.4 micromoles/L (>9 micrograms/dL) in a child or >1.2 micromoles/L (>24 micrograms/dL) in an adult are currently considered to require active interventions. Toxicity occurs at lower levels, but prevention is the approach to preventing such toxicity in the absence of effective management options at such levels.
History and exam
- presence of risk factors
- FHx of lead poisoning or parental work with lead
- cognitive impairment (children)
- behavioural changes (children)
- headaches (children)
- clumsiness and agitation (children)
- loss of appetite (children)
- constipation (children)
- somnolence (children)
- altered mental state
- cerebellar signs
- age 9 to 36 months
- housing with lead hazards
- occupational lead exposure
- lead-contaminated water supplies
- low socioeconomic status
- hobbies working with lead
- use of folk medications
- fetal exposure
- mineral-deficient and high-fat diets
- hand-to-mouth activity with toys and other objects
- working in bullet firing ranges
Professor Emeritus of Pediatrics
Medical University of South Carolina
JRR declares that he has no competing interests.
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
HH is an author of a reference cited in this monograph. HH has received research funding greater than 6 figures USD.
Occupational & Environmental Medicine
Cambridge Health Alliance
Associate Professor of Medicine
Harvard Medical School
Associate Professor of Environmental Health Sciences
Harvard School of Public Health
School of Medicine
University of Western Sydney
AJ declares that she has no competing interests.
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