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
诊断性检查
首要检查
- 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
需考虑的检查
- 24-hour urine lead with chelation
- abdominal radiographs
- nerve conduction studies
治疗流程
all patients
撰稿人
作者
J. Routt Reigart, MD
Professor Emeritus of Pediatrics
Medical University of South Carolina
Charleston
SC
利益声明
JRR declares that he has no competing interests.
同行评议者
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
利益声明
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
利益声明
None disclosed.
Alison Jones, MD, FRCPE, FiBIOL, FRCP, FRACP
Dean
School of Medicine
Campbelltown Campus
University of Western Sydney
Australia
利益声明
AJ declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
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].全文
Centers for Disease Control and Prevention (CDC). Blood lead levels: United States, 1988-1991. MMWR Morb Mortal Wkly Rep. 1994;43:545-548.全文 摘要
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.全文
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.全文 摘要
Mahaffey KR. Nutrition and lead: strategies for public health. Environ Health Perspect. 1995;103(suppl 6):191S-196S.全文 摘要
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.全文 摘要
Yeoh B, Woolfenden S, Lanphear B, et al. Household interventions for preventing domestic lead exposure in children. Cochrane Database Syst Rev. 2014;(12):CD006047.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Iron deficiency anemia
- Non-lead peripheral neuropathy
- Arsenic poisoning
更多 鉴别诊断指南
- Childhood lead poisoning prevention
- WHO guideline for clinical management of exposure to lead
更多 指南
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