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Lead poisoning

Lead poisoning
Other namesPlumbism, colica pictorum, saturnism, Devon colic, painter's colic
An X-ray demonstrating the characteristic finding of lead poisoning in humans—dense metaphyseal lines
SpecialtyToxicology
SymptomsIntellectual disability, abdominal pain, constipation, headaches, irritability, memory problems, inability to have children, tingling in the hands and feet[1][2]
ComplicationsAnemia, seizures, coma[1][2]
CausesExposure to lead via contaminated air, water, dust, food, consumer products[2]
Risk factorsYoung age, pica[2]
Diagnostic methodBlood lead level[2]
Differential diagnosisIron deficiency anemia, malabsorption, ADHD, anxiety disorder, polyneuropathy[3]
PreventionRemoving lead from the home, improved monitoring and education in the workplace, laws that ban lead in products[2][4][5][6]
TreatmentChelation therapy[4]
MedicationDimercaprol, edetate calcium disodium, succimer[7]
Deaths540,000 (2016)[2]

Lead poisoning, also known as plumbism and saturnism, is a type of metal poisoning caused by lead in the body.[2] Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, infertility, and tingling in the hands and feet.[1] It causes almost 10% of intellectual disability of otherwise unknown cause and can result in behavioral problems.[2] Some of the effects are permanent.[2] In severe cases, anemia, seizures, coma, or death may occur.[1][2]

Exposure to lead can occur by contaminated air, water, dust, food, or consumer products.[2] Lead poisoning poses a significantly increased risk to children as they are far more likely to ingest lead indirectly by chewing on toys or other objects that are coated in lead paint.[2] Additionally, children absorb greater quantities of lead from ingested sources than adults. Exposure at work is a common cause of lead poisoning in adults with certain occupations at particular risk.[7] Diagnosis is typically by measurement of the blood lead level.[2] The Centers for Disease Control and Prevention (US) has set the upper limit for blood lead for adults at 10 μg/dL (10 μg/100 g) and for children at 3.5 μg/dL;[8] before October 2021 the limit was 5 μg/dL.[9][10] Elevated lead may also be detected by changes in red blood cells or dense lines in the bones of children as seen on X-ray.[4]

Lead poisoning is preventable.[2] This includes individual efforts such as removing lead-containing items from the home,[5] workplace efforts such as improved ventilation and monitoring,[6] state and national policies that ban lead in products such as paint, gasoline, ammunition, wheel weights, and fishing weights, reduce allowable levels in water or soil, and provide for cleanup of contaminated soil.[2][4] Workers' education could be helpful as well.[11] The major treatments are removal of the source of lead and the use of medications that bind lead so it can be eliminated from the body, known as chelation therapy.[4] Chelation therapy in children is recommended when blood levels are greater than 40–45 μg/dL.[4][12] Medications used include dimercaprol, edetate calcium disodium, and succimer.[7]

In 2013, lead is believed to have resulted in 853,000 deaths worldwide.[2] It occurs most commonly in the developing world.[2] There also are numerous cases in the developed world, with there being thousands of American communities with higher lead burdens than seen during the peak of the Flint water crisis.[13] Those who are poor are at greater risk.[2] Lead is believed to result in 0.6% of the world's disease burden.[5] According to a study, half of the US population has been exposed to substantially detrimental lead levels in early childhood – mainly from car exhaust, from which lead pollution peaked in the 1970s and caused widespread loss in cognitive ability.[14][15][globalize]

People have been mining and using lead for thousands of years.[4] Descriptions of lead poisoning date to at least 200 BC,[4] while efforts to limit lead's use date back to at least the 16th century.[5] Concerns for low levels of exposure began in the 1970s with there being no safe threshold for lead exposure.[2][4][16]

  1. ^ a b c d "Lead Information for Workers". CDC. 30 September 2013. Archived from the original on 18 October 2016. Retrieved 14 October 2016.
  2. ^ a b c d e f g h i j k l m n o p q r s t "Lead poisoning and health". WHO. September 2016. Archived from the original on 18 October 2016. Retrieved 14 October 2016.
  3. ^ Ferri FF (2010). "L". Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders (2nd ed.). Philadelphia, PA: Elsevier/Mosby. ISBN 978-0-323-07699-9.
  4. ^ a b c d e f g h i Dapul H, Laraque D (August 2014). "Lead poisoning in children". Advances in Pediatrics. 61 (1): 313–33. doi:10.1016/j.yapd.2014.04.004. PMID 25037135.
  5. ^ a b c d Needleman H (2004). "Lead poisoning". Annual Review of Medicine. 55: 209–22. doi:10.1146/annurev.med.55.091902.103653. PMID 14746518.
  6. ^ a b "Lead Information for Employers". CDC. 30 September 2013. Archived from the original on 18 October 2016. Retrieved 14 October 2016.
  7. ^ a b c Gracia RC, Snodgrass WR (January 2007). "Lead toxicity and chelation therapy". American Journal of Health-System Pharmacy. 64 (1): 45–53. doi:10.2146/ajhp060175. PMID 17189579.
  8. ^ "CDC Updates Blood Lead Reference Value for Children". Centers for Disease Control and Prevention. 28 October 2021. Archived from the original on Sep 22, 2023.
  9. ^ "Blood Lead Reference Value | Lead". Centers for Disease Control and Prevention. 2021-10-28. Retrieved 2021-12-01.
  10. ^ The Code of Federal Regulations of the United States of America. U.S. Government Printing Office. 2005. p. 116. Archived from the original on 2017-11-05.
  11. ^ Allaouat S (2020). "Educational interventions for preventing lead poisoning in workers. Cochrane Database of Systematic Reviews 2020". Cochrane Database of Systematic Reviews. 2020 (8): CD013097. doi:10.1002/14651858.CD013097.pub2. PMC 8095058. PMID 35819457. S2CID 226951902.
  12. ^ "What Do Parents Need to Know to Protect Their Children?". CDC. 30 October 2012. Archived from the original on 9 October 2016. Retrieved 14 October 2016.
  13. ^ Laborers' Health and Safety Fund of North America (11 February 2017). "Thousands of US Cities Have Worse Lead Problems Than Flint". Archived from the original on 26 September 2021. Retrieved 26 September 2021.
  14. ^ "Lead exposure in last century shrunk IQ scores of half of Americans". Duke University. Retrieved 18 April 2022.
  15. ^ McFarland MJ, Hauer ME, Reuben A (15 March 2022). "Half of US population exposed to adverse lead levels in early childhood". Proceedings of the National Academy of Sciences. 119 (11): e2118631119. Bibcode:2022PNAS..11918631M. doi:10.1073/pnas.2118631119. ISSN 0027-8424. PMC 8931364. PMID 35254913.
  16. ^ Needleman HL, Gunnoe C, Leviton A, Reed R, Peresie H, Maher C, Barrett P (29 March 1979). "Deficits in Psychologic and Classroom Performance of Children with Elevated Dentine Lead Levels". New England Journal of Medicine. 300 (13): 689–695. doi:10.1056/NEJM197903293001301. PMID 763299. Retrieved 17 November 2020.

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