Lead Poisoning

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Basics

Description

  • Disease resulting from a high body burden of lead (Pb)—an element with no known physiologic value
  • Synonym(s): lead poisoning, inorganic

Epidemiology

  • Predominant age: 1 to 5 years, adult workers
  • Predominant sex: male > female (1:1 in childhood)

Prevalence
  • Centers for Disease Control and Prevention (CDC) estimates half a million U.S. children aged 1 to 5 years have blood Pb levels >5 μg/dL. Levels vary among communities and populations.
  • In 2016, 12,574 children in the United States were noted with a blood Pb level ≥10 μg/dL, down from 17,246 in 2012.

Etiology and Pathophysiology

  • Inhalation of Pb dust or fumes, or ingestion of Pb
  • Pb replaces calcium in bones. Pb interferes with heme synthesis, causes interstitial nephritis, and interferes with neurotransmitters, especially glutamine; high levels affect blood–brain barrier and lead to encephalopathy, seizures, and coma.
  • Early life Pb exposure causes methylation changes leading to epigenetic alterations that may predispose to brain dysfunction.

Risk Factors

  • Children with pica or with iron-deficiency anemia
  • Residence in or frequent visitor to deteriorating pre-1960 housing with Pb-painted surfaces or recent renovation
  • Soil/dust exposure near older homes, Pb industries, or urban roads
  • Sibling or playmate with current or past Pb poisoning
  • Dust from clothing of Pb worker or hobbyist
  • Pb dissolved in water from Pb or Pb-soldered plumbing (e.g., Flint, Michigan 2014 to 2015)
  • Pb-glazed ceramics leach (especially with acidic food or drink)
  • Folk remedies and cosmetics
    • Mexico: Azarcon, Greta
    • Dominican Republic: litargirio, a topical agent
    • Asia and Middle East: chuifong tokuwan, pay-loo-ah, ghasard, bali goli, kandu, ayurvedic herbal medicine from South Asia, kohl (alkohl, ceruse), surma, saoott, cebagin
  • Hobbies: target shooting, glazed pottery making, Pb soldering, preparing Pb shot or fishing sinkers, stained-glass making, car/boat repair, home remodeling
  • Occupational exposure: plumbers, pipe fitters, Pb miners, auto repairers, glass manufacturers, ship builders, printer operators, plastic manufacturers, Pb smelters and refiners, steel welders or cutters, construction workers, rubber product manufacturers, battery manufacturers, bridge reconstruction workers, firing range workers, military and law enforcement
  • Dietary: zinc or calcium deficiency
  • Imported toys with Pb
  • Retained bullet fragments
Pediatric Considerations
  • Children are at increased risk because of incomplete development of the blood–brain barrier prior to 3 years of age (allowing more Pb into the CNS).
  • Ingested Pb has 40% bioavailability in children (10% in adults).
  • Common childhood behaviors such as frequent hand-to-mouth activity and pica (repeated ingestion of nonfood products) increase the risk of Pb ingestion.

Pregnancy Considerations
Cross-sectional studies suggest an association between elevated blood Pb and preeclampsia.

General Prevention

  • Counsel families on sources of Pb and how to decrease exposure. Screen high-risk children (1)[C].
  • Warn parents about unsafe home renovations.
  • Wet mopping and dusting with a high-phosphate solution (e.g., powdered automatic dishwasher detergent with 1/4 cup per gallon of water) helps control Pb-bearing dust. High-phosphate detergent is no longer available in some states.
  • If tap water is potentially Pb contaminated, use cold water instead of hot water and run for 30 to 60 seconds to flush pipes. Use Pb-free water source if possible (bottled or distilled water).
  • Screen at-risk pregnant women (2)[C].

Commonly Associated Conditions

Iron-deficiency anemia

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