Lead toxicity

Last reviewed: 27 Aug 2022
Last updated: 11 Mar 2022

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
More key diagnostic factors

Other diagnostic factors

  • colicky abdominal pain (adults)
  • hypertension (adults)
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • whole-blood lead level
  • complete blood count
  • serum ferritin
More 1st investigations to order

Investigations to consider

  • 24-hour urine lead with chelation
  • abdominal radiographs
  • nerve conduction studies
More investigations to consider

Emerging tests

  • x-ray fluorescence of long bones
  • MRI brain

Treatment algorithm

ACUTE

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.

  • Differentials

    • Iron deficiency anemia
    • Non-lead peripheral neuropathy
    • Arsenic poisoning
    More Differentials
  • Guidelines

    • Childhood lead poisoning prevention
    • WHO guideline for clinical management of exposure to lead
    More Guidelines
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