Exposure to Lead

Patient Guideline Summary

Publication Date: October 26, 2021

Last Updated: March 2, 2023

Objective

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

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

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

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.