Exposure to Lead
Patient Guideline Summary
- 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.
- 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.
- 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.
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)