What is a normal lead level in micrograms per deciliter (mcg/dL)?

From the Guidelines

Normal lead levels in children should be below 5 μg/dL, with the geometric mean blood lead concentration for US children 1–5 years old being less than 2 μg/dL. According to the American Academy of Pediatrics, as stated in the 2016 study 1, the current reference value for case management is ≥5 μg/dL. This threshold is crucial in identifying children who have unacceptably high exposure to lead and in setting public health goals. It is essential to note that there is no safe level of lead exposure, and even low levels can cause health problems, particularly in children and pregnant women.

Key Points to Consider

• The geometric mean blood lead concentration for US children 1–5 years old is less than 2 μg/dL, as mentioned in the study 1.
• Children with blood lead concentrations <5 μg/dL should have their laboratory results reviewed with their family, and their blood lead concentration should be repeated in 6–12 months if they are at high risk for lead exposure, as recommended in the study 1.
• For children with blood lead concentrations between 5–14 μg/dL, it is crucial to perform steps as described for blood lead concentrations <5 μg/dL, retest venous blood lead concentration within 1–3 months, and provide nutritional counseling related to calcium and iron, as outlined in the study 1.
• The study 1 emphasizes the importance of monitoring children who have blood lead concentrations <10 μg/dL and considering environmental investigations to identify sources of lead exposure for children with blood lead concentrations ≥5 μg/dL.

Recommendations for Management

• For children with elevated blood lead concentrations, it is essential to monitor them until environmental investigations and remediation are complete and blood lead concentrations decline, as stated in the study 1.
• The pediatrician should inform the local or state health department and request an inspection of the child’s house to identify and remediate any lead hazards, as recommended in the study 1.
• Screening children for iron deficiency and insufficient dietary calcium intake is also crucial, as mentioned in the study 1.

From the Research

Normal Lead Levels

• A normal lead level in children is generally considered to be less than 5 micrograms per deciliter (mcg/dL) 2
• The Centers for Disease Control and Prevention (CDC) has defined the blood lead level that should prompt public health actions as 10 microg/dL 3
• In adults, a blood lead concentration of less than 45 microg/dL is generally not considered to be a concern for lead toxicity 4

Blood Lead Level Guidelines

• The CDC recommends screening all Medicaid-eligible children at 12 months and again at 24 months, or at least once between 36 and 72 months if not previously screened 2
• Universal screening is recommended in areas where more than 27% of the housing was built before 1950, or where at least 12% of children 12 to 36 months of age have blood lead levels greater than 10 mcg/dL 2
• Blood lead levels of less than 10 mcg/dL are associated with impairments in neurocognitive and behavioral development that are irreversible 2

Management of Lead Poisoning

• Life-threatening lead levels are treated with chelation therapy, and lower levels should prompt case management and environmental investigations to identify and remove the source of exposure 2
• Chelation is generally not indicated for adults with blood lead concentrations of less than 45 microg/dL due to the potential risk of adverse drug events and concerns about remobilized lead 4
• The management of childhood lead poisoning has evolved over time, with a shift towards using oral agents such as penicillamine and 2,3-dimercaptosuccinic acid to reduce elevated lead levels 5