Exposure to Lead

Patient Guideline Summary

Publication Date: October 27, 2021
Last Updated: March 2, 2023

Objective

Objective

This patient summary means to discuss key recommendations from the World Health Organization (WHO) for managing lead exposure.

Overview

Overview

  • Lead is a common industrial chemical, but it is toxic. It is a major cause of intellectual disability in children and contributes to heart and vascular disease in adults.
  • Children in sub-standard living conditions are at greatest risk of lead exposure.
  • Lead can be inhaled as fumes or ingested as contaminants in food, soil, paint or traditional medicines.
  • Lead poisoning can cause headache, abdominal pain, constipation, joint pain, lethargy, convulsions, anemia and damage to brain, kidney and liver.
  • Chelation is a treatment that traps and removes lead from your body.
  • This patient summary focuses on managing exposures to lead. It primarily concerns people in poor living conditions in developing nations.

Diagnosis

Diagnosis

  • If you are at risk, you should have adequate information to enable avoiding lead exposure.
  • If you are suspected of lead exposure, you should have an appropriate blood test.
  • Values over 5 micrograms per deciliter (μg/dL) should initiate efforts to reduce or terminate exposure.

Treatment

Treatment

  • Objects made of lead or containing lead in your or your child’s digestive tract should be removed if practical.
  • Children and pregnant or lactating women should be assured an adequate calcium intake.
  • Children at risk of iron anemia should receive iron supplements.
  • Children with lead levels over 45 μg/dL should receive chelation therapy.
  • Children with lead levels 40–44 μg/dL should be considered for chelation therapy.
  • Children with lead levels over 70 μg/dL should also be closely monitored for symptoms of neurological toxicity.
  • If encephalopathy (brain damage) is discovered, urgent hospital care is recommended.
  • Non-pregnant females of child-bearing age with lead levels 45–70 μg/dL should be considered for chelation.
  • Males over age 11 and women past child-bearing age with lead levels 45–70 μg/dL but no signs of lead poisoning require only a 2–4-week follow-up with a blood test.
  • Chelation should be considered for non-pregnant adolescents and adults with blood lead concentrations of 45–70 μg/dL who have mild-moderate clinical features of lead poisoning (such as abdominal pain, constipation, arthralgia, headache, lethargy), therapy is suggested.
  • Everyone not pregnant and over age 10 with lead levels over 70 μg/dL should be closely followed and receive chelation treatment.
    • If they have significant symptoms (irritability, drowsiness, ataxia, convulsions, coma) chelation should be urgent.

Pregnancy
Note: There is little experience with chelation during pregnancy. Therefore, risks must be carefully weighed against benefits when considering chelation.
  • Pregnant women with lead encephalopathy require urgent chelation.
  • If, in the 2nd or 3rd trimester, lead levels are over 45 μg/dL and encephalopathy is not present, chelation is recommended.
    • If in the 1st trimester, inadequate evidence precludes a recommendation.

Available chelating agents
  • Dimercaptol (injection)
  • D-penicillamine (oral)
  • Sodium calcium edetate (injection)
  • Succimer (oral)

Source Citation

WHO guideline for clinical management of exposure to lead [Internet]. Geneva: World Health Organization; 2021. PMID: 34787987.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.