From the Guidelines
Lead poisoning is a serious condition that can cause significant morbidity and mortality, particularly in children, and prompt removal from exposure and chelation therapy are crucial for management, as evidenced by the most recent and highest quality study 1.
Effects of Lead Poisoning
The effects of lead poisoning can be severe and long-lasting, particularly in children, and include:
- Diminished intellectual and academic abilities
- Higher rates of neurobehavioral disorders such as hyperactivity and attention deficits
- Lower birth weight in children
- Significant overt symptoms, such as protracted vomiting and encephalopathy, and even death at very high blood lead concentrations (eg, >100 μg/dL)
Management and Prevention
Management of lead poisoning involves:
- Removal from lead exposure
- Chelation therapy, which may be considered on a case-by-case basis for lower blood lead levels (10-45 μg/dL)
- Identifying and removing the source of exposure, such as lead paint, contaminated soil, water pipes, or occupational hazards
- Prevention is crucial and involves primary prevention, reducing or eliminating the myriad sources of lead in the environment of children before exposure occurs, as recommended by the most recent study 1
Key Recommendations
The most effective way to prevent or control childhood lead exposure is by reducing lead exposure from residential lead hazards, industrial sources, contaminated foods or water, and other consumer products, as stated in the study 1. Key recommendations for health-based medical surveillance for lead-exposed workers include:
- Baseline or preplacement medical history and physical examination, baseline blood lead level (BLL), and serum creatinine
- Regular monitoring of BLL, with frequency depending on level of exposure and BLL
- Removal from exposure if repeat BLL measured in 4 weeks remains ≥ 20 μg/dL, or if first BLL ≥ 30 μg/dL, as outlined in the study 1
From the Research
Effects of Lead Poisoning
The effects of lead poisoning (plumbism) can be severe and varied. Some of the key effects include:
- Hematological, gastrointestinal, and neurological dysfunction 2
- Chronic nephropathy, hypertension, and reproductive impairment with severe or prolonged exposure 2
- Inhibition of certain enzymes, alteration of cellular calcium metabolism, and stimulation of synthesis of binding proteins in kidney, brain, and bone 2
- Slowing down of nerve conduction 2
Symptoms of Lead Poisoning
Symptoms of lead poisoning may include:
- Abdominal pain, constipation, and vomiting 3
- Neurological symptoms, such as encephalopathy 4
- Non-specific early clinical features, making diagnosis challenging without an occupational history 4
Management and Treatment
Management and treatment of lead poisoning may involve:
- Chelation therapy with agents such as dimercaprol, edetate calcium disodium, and succimer 5, 4
- Combination chelation therapy in severe cases 3
- Education and risk assessment to prevent further exposure 5
- Treatment with sodium calciumedetate and succimer for symptomatic patients with high blood lead concentrations 4
Blood Lead Concentration
Blood lead concentration is an important marker for inorganic lead exposure, with: