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Lead Poisoning

Lead Poisoning is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Consequence of 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.
  • 2013 case prevalence rate blood Pb level ≥10 μg/dL is 20 per 100,000 employed adults, a slight decline over the prior 3 years

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 lead 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 (Example: 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 or boat repair, home remodeling
  • Occupational exposure: plumbers, pipe fitters, Pb miners, auto repairers, glass manufacturers, shipbuilders, 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 at <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.

General Prevention

  • Counsel families on sources of Pb and methods to decrease Pb exposure. Screen children at high risk (1)[C].
  • Warn parents about the dangers posed by unsafe home renovations.
  • Wet mopping and dusting with a high-phosphate solution (e.g., powdered automatic dishwasher detergent with 1/4 cup/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, preferentially use cold water instead of hot water and run for 30 to 60 seconds to flush pipes. Preferentially use Pb-free water source if available (bottled or distilled water).
  • Screen at-risk pregnant women (2)[C].

Commonly Associated Conditions

Iron-deficiency anemia

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Citation

Stephens, Mark B., et al., editors. "Lead Poisoning." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816799/all/Lead_Poisoning.
Lead Poisoning. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816799/all/Lead_Poisoning. Accessed April 20, 2019.
Lead Poisoning. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816799/all/Lead_Poisoning
Lead Poisoning [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 20]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816799/all/Lead_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Lead Poisoning ID - 816799 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816799/all/Lead_Poisoning PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -