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Lead Poisoning
OVERVIEW: Lead poisoning is a toxic condition that results from exposure to lead, an element with no
known function in the human body.
SIGNS AND SYMPTOMS: • Often no symptoms
• Mild to moderate toxicity:
• May cause muscle or joint pain, loss of sensation, fatigue, irritability, lethargy, abdominal discomfort, difficulty concentrating, headache, tremor, vomiting, weight loss
• Severe toxicity:
• Causes loss of appetite, metallic taste in mouth, constipation, severe abdominal cramps Neuromuscular type: peripheral neuritis
• Seizures; coma; and long-term effects including brain damage, retarded mental development, hyperactivity
• Chronic exposure to lead may cause renal failure.
CAUSES: Inhalation of lead dust or fumes or ingestion of lead
SCOPE: 17% of preschoolers in the United States have lead poisoning. Sporadic cases have been
reported in adults.
MOST OFTEN AFFECTED: • Children 1-5 years old; adult workers in industries that use lead
• Males and females are affected in equal numbers.
RISK FACTORS: • Children who eat nonfood items (e.g., dirt)
• Children with iron deficiency anemia
• Residence or frequent visitor in deteriorating, pre-1960 housing with lead-paint surfaces
• Children with seizures
• Children with hyperkinetic or autistic behavior
• Sibling or playmate with lead poisoning
• Dust from clothing of lead worker
• Lead dissolved in water from lead or lead-soldered plumbing
• Lead-glazed ceramics, especially with acidic food or drink
• Food stored in inverted plastic bread bags printed with colored ink
• Colored comics
• Soil near lead industries and roads
• Folk remedies
• Hobbies
• Occupational exposure
• Dietary: zinc or calcium deficiency
DIAGNOSIS PHYSICAL EXAMINATION: The Physician will perform a physical examination to identify the signs and symptoms of lead
poisoning.
TESTS AND PROCEDURES: • Blood tests
• X-ray of the abdomen or long bones
TREATMENT GENERAL MEASURES: • Lead poisoning is often managed in the outpatient setting.
• Hospitalization may be required for chelation therapy.
• Local health department may be notified.
ACTIVITY: Avoid activity at any site of potential lead contamination.
DIET: • If symptomatic, avoid excessive fluids.
• Consume adequate calcium and iron.
• Eat a low-fat diet to reduce absorption and retention of lead.
MEDICATIONS COMMONLY PRESCRIBED DRUGS: • Oral chelation: succimer (Chemet, dimercaptosuccinic acid, DMSA)
• Intravenous (IV) chelation: dimercaprol (British anti-Lewisite, BAL), Ca EDTA (edetate calcium disodium)
• Diazepam (Valium)
CONTRAINDICATIONS: BAL should not be given to persons allergic to peanuts (the drug solution contains peanut oil).
PRECAUTIONS: Chelation drugs have many precautions; read drug product information.
DRUG INTERACTIONS: Vitamins should not be given concurrently with oral chelation.
Other Drugs: • Penicillamine (d-penicillamine, Depen, Cuprimine)
FOLLOW UP PATIENT MONITORING: • The Physician should be seen after 7-10 days and then 1-2 times per month.
• Testing should be periodically repeated; e.g., every 3 months.
PREVENTION/AVOIDANCE: • Identify potential sources of lead and decrease lead exposure. Wet mopping and dusting with a high-phosphate solution (e.g., powdered automatic dishwasher detergent, 1/4 cup per gallon of water) will help control lead-bearing dust.
• If the source is in the home (e.g., lead paint), the patient must reside elsewhere until lead removal is completed.
COMPLICATIONS: • Oral chelation: succimer (Chemet, dimercaptosuccinic acid, DMSA)
• Intravenous (IV) chelation: dimercaprol (British anti-Lewisite, BAL), Ca EDTA (edetate calcium disodium)
• Diazepam (Valium)
WHAT TO EXPECT: • Symptomatic lead poisoning without brain damage generally improves with chelation, but subtle effects may be long-lasting or permanent.
• If brain damage occurs, permanent effects (mental retardation, seizure disorder, blindness, paralysis) are seen in 25 to 50% of patients.
MISCELLANEOUS OTHER FACTORS: N/A
PEDIATRIC: • Increasing evidence exists that low-lead level exposure may be toxic to children.
• Children are at increased risk because of incomplete development of the brain.
• Common childhood behaviors such as frequent hand-to-mouth activity and pica (ingestion of nonfood products) greatly increase the risk of ingesting lead.
GERIATRIC: N/A
OTHERS: N/A
PREGNANCY: • Lead exposure in pregnancy is associated with reduced birth weight and premature birth.
• Lead causes birth defects in animals.
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