Symptoms and Treatment of Lead Poisoning
Lead poisoning presents with a wide spectrum of multisystemic adverse effects ranging from subtle subclinical changes to life-threatening intoxication, requiring prompt identification and blood lead level-based treatment. 1
Symptoms of Lead Poisoning
Neurological Symptoms
- Cognitive dysfunction including memory problems, difficulty concentrating, and reduced intellectual capacity 1
- Irritability and behavioral changes, particularly common in children 2
- Headache and circumoral paresthesia (numbness around the mouth) 3
- Developmental delays and decreased intelligence in children 2
Gastrointestinal Symptoms
- Abdominal pain, which can be severe and recurring 4
- Nausea, vomiting, and diarrhea 3
- Loss of appetite 5
Cardiovascular Symptoms
Hematological Effects
- Anemia, often with basophilic stippling of red blood cells 4
- Potential hemorrhagic tendencies with excessive lead exposure 3
Other Symptoms
- Weakness and dizziness 5
- Generalized body ache 5
- Anxiety 5
- Reproductive problems including decreased fertility 1, 2
- Renal dysfunction 1, 2
- Skin manifestations including exfoliative dermatitis 3
Diagnosis of Lead Poisoning
- Blood lead level (BLL) is the primary diagnostic test for lead poisoning 1, 2
- Abdominal radiography should be considered for children with pica behavior 1, 2
- Serum creatinine measurement to identify individuals with chronic renal dysfunction 1
- Lead poisoning can be misdiagnosed as acute porphyria or nonspecific abdominal pain; testing for heme precursors in urine is key to differential diagnosis 4
Treatment Protocol Based on Blood Lead Levels
For Children
- BLL <5 μg/dL: Review results with family, provide anticipatory guidance, assess nutrition and development, repeat testing in 6-12 months if high risk 2
- BLL 5-14 μg/dL: Notify local health authorities, identify and eliminate lead sources, retest within 1-3 months, provide nutritional counseling, screen for iron deficiency, monitor development closely 2
- BLL >45 μg/dL: Chelation therapy is indicated 1, 2
For Adults
- BLL 10-19 μg/dL: Test every 3 months 1
- BLL ≥20 μg/dL: Test monthly until levels decline 1
- BLL ≥20 μg/dL (repeat measurement in 4 weeks) or first BLL ≥30 μg/dL: Removal from occupational exposure 1
- BLL 80-99 μg/dL: Consider chelation therapy regardless of symptoms 1
- BLL ≥70 μg/dL with symptoms: Chelation therapy indicated 1, 2
- BLL ≥100 μg/dL: Urgent medical evaluation and chelation therapy almost always warranted 1, 2
Chelation Therapy
- Chelation therapy is typically administered over 5 days 2
- Options for chelation include:
Special Considerations
- Pregnant women should avoid lead exposure that would result in BLL >5 μg/dL 1, 2
- Calcium supplementation during pregnancy is especially important for women with past exposure to lead 1
- Breastfeeding should be encouraged for most women, with decisions for those with very high lead exposure addressed individually 1
- Use edetate disodium with caution in patients with heart disease, limited cardiac reserve, or incipient congestive failure 3
- Monitor for hypokalemia and hypomagnesemia during chelation therapy 3
- Edetate disodium can lower blood sugar and insulin requirements in diabetic patients 3
Prevention and Follow-up
- Identify and eliminate sources of lead exposure 2, 5
- Environmental investigation is essential to remove the source of exposure 7
- Primary prevention strategies are essential to eliminate harmful effects of lead on child development 7
- Regular monitoring of BLLs until decline is observed 1
- Assess renal function before and during treatment with chelation therapy 3