- Disease resulting from a high body burden of lead (Pb)—an element with no known physiologic purpose
- Synonym(s): lead poisoning, inorganic
- Predominant age: 1 to 5 years, adult workers
- Predominant sex: male > female (1:1 in childhood)
- 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 2017, 11,097 children in the United States were noted with a blood Pb level ≥10 μg/dL, down from 17,246 in 2012.
- CDC estimates suggest that Pb poisoning prevention has significantly reduced the number of children with blood Pb levels over 1 μg/dL.
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 Pb levels can lead to encephalopathy, seizures, and coma.
- Pb crosses blood–brain barrier by displacing calcium ions—the developing nervous system is particularly vulnerable to the toxic effects of Pb.
- Pb exposure early in life causes methylation changes leading to epigenetic alterations that may predispose to brain dysfunction.
- Children with pica or with iron deficiency anemia
- Residence in or frequent visitation to deteriorating pre-1978 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 leachate (especially with acidic food or drink)
- Folk remedies, spices, 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 or jewelry with Pb
- Retained bullet fragments, especially if multiple fragments, associated with fracture, or in joints
- 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 40% bioavailable 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.
Cross-sectional studies suggest an association between elevated blood Pb and preeclampsia.
- 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).
- Consider screening at-risk pregnant women (2)[C].
Commonly Associated Conditions
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Domino, Frank J., et al., editors. "Lead Poisoning." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816799/all/Lead_Poisoning.
Lead Poisoning. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816799/all/Lead_Poisoning. Accessed June 4, 2023.
Lead Poisoning. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816799/all/Lead_Poisoning
Lead Poisoning [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 04]. 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 - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, 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 -