Health Library Lead PoisoningFrom Healthwise

What is lead poisoning?

Lead poisoning occurs when you absorb too much lead by breathing or swallowing a substance with lead in it, such as food, dust, paint, or water. Too much lead in the body can cause irreversible problems in growth and development in children, including:

• Behavior problems.
• Hearing problems.
• Learning problems.
• Slowed growth.

In adults, lead poisoning can cause serious health problems, including high blood pressure and damage to the brain, nervous system, stomach, and kidneys.

Although it is not normal to have lead in your body, a small amount is present in most people. Lead can damage almost every organ system, with the most harm caused to the brain, nervous system, kidneys, and blood.

What causes lead poisoning?

Lead poisoning is usually caused by months or years of exposure to small amounts of lead in the home, work, or day care environment. It can also happen very quickly with exposure to high concentrations. The most common source of lead exposure for children is lead-based paint and dust and soil that are contaminated by it, especially in older homes and buildings.¹ Some estimates say that as many as three-quarters of dwellings built before 1980 have indoor surfaces painted with lead-containing paint.² Toys and jewelry made in other countries can sometimes contain high lead levels. For a list of recalled products, see the Consumer Product Safety Commission Web site at www.cpsc.gov.

Adults are most often exposed to lead in the workplace or while doing hobbies. Those who work with lead—such as metal smelters, welders, or pottery makers—are at a higher risk of lead poisoning.³

Other sources of lead exposure include:

• Contaminated air (including industrial emissions), water, and soil.
• Certain hobbies, such as working with stained glass, building lead-based models, reloading ammunition, or shooting at indoor ranges.
• Some alternative medicines and supplements, such as certain vitamins from India.⁴
• Eating food or juice stored in cans made with lead or glazed with lead-based glazes, which are not manufactured in the United States.

Most people are exposed to some amount of lead in their lifetime. Although environmental regulations have reduced lead exposure in the United States, it is still a significant health risk, especially for young children. It is estimated that lead poisoning affects over 310,000 children in the U.S.⁵

What are the symptoms?

There may be no noticeable symptoms of lead poisoning because the effects are subtle or may mimic other conditions. When lead poisoning levels are severe, some general symptoms can include digestive problems, fatigue, headaches, and higher rates of tooth decay.

Children with chronic lead poisoning may show slightly lower intelligence and may be smaller in size than children their age who do not have lead poisoning. Behavioral problems can include irritability or aggressiveness, hyperactivity, learning difficulties, lethargy, and loss of appetite.

In adults, behavioral symptoms can include irritability, mood and personality changes, changes in sleep patterns, difficulty concentrating, and memory loss.

At high levels, lead can affect the central nervous system, leading to poor coordination, weakness in hands and feet, headaches, and in severe cases, convulsions, paralysis, and coma.

How is lead poisoning diagnosed?

A lead blood test measures the amount of lead in the blood. Although this test does not measure the complete level of lead in the body, it is the best test available at this time.

A urine sample collected over 24 hours and tested for lead can give an information about the total lead in the body (body lead burden) and is often used before treatment to remove lead (chelation therapy) is started.

Diagnosing lead poisoning is difficult because the symptoms can be caused by many diseases. Most children with lead poisoning do not have symptoms until their blood lead levels are very high. A blood lead test is necessary to identify these children.⁶

How is it treated?

Treatment for lead poisoning includes removing the source of lead exposure and eating a balanced diet. Adequate nutrition, especially sufficient iron intake, helps prevent absorption of lead. Often this treatment approach is enough to reduce lead levels in the body. If this is not successful or if lead levels are very high, chelation therapy may be used. Chelation therapy involves taking medicines that bind to lead in the body and help speed its elimination through the kidneys.

It is important to make sure that children are not exposed to lead. The most effective means of prevention is to keep children out of buildings that contain lead-based paint until the lead has been either removed or sealed away and the environment is certified by professionals to be free of lead residues.

Who is at highest risk of lead poisoning?

Lead poisoning can occur at any age, but children are most vulnerable to contamination. Children who are at highest risk for lead poisoning include those who:

• Live in homes or buildings built before 1978, especially if built before 1950 when lead-based paint was commonly used.
• Reside in the inner cities rather than the suburbs in the United States.⁷
• Have been adopted or recently immigrated from countries where lead poisoning is common, such as China.⁸
• Are between the ages of 1 to 5 years. Babies and young children are most vulnerable to lead poisoning because they:
  • Often put their hands and objects in their mouths.
  • Sometimes swallow nonfood items.
  • Have higher gastrointestinal absorption of lead.
  • Have brains that are rapidly developing.

Additionally, lead exposure or lead poisoning may occur in:

• People whose drinking water flows through lead-soldered pipes.
• Adults who work with lead either in their occupation or as a hobby, such as metal smelters, pottery makers, or stained glass artists.
• People who eat food from cans made with lead solder, which are manufactured outside the United States.
• People who use ceramic containers for cooking or storing food or beverages. Some ceramic glaze contains lead that may have been improperly fired or cured.
• People who eat or breathe traditional or folk remedies that contain lead, such as some herbs and vitamins from India.⁴
• People who live in communities contaminated by industrial emissions.

Frequently Asked Questions

Lead poisoning is caused by swallowing or breathing lead-contaminated substances. Small children may get lead poisoning by licking, chewing, or eating lead-based paint on toys, jewelry, or woodwork such as windowsills. In 2007, the U.S. Consumer Product Safety Commission (CPSC) found high lead content in many children’s toys and jewelry made in other countries. For a complete list of recalled products, see the CPSC Web site at www.cpsc.gov.

Small children also may be exposed by breathing, swallowing, or playing in lead-contaminated dust or soil.

Although lead poisoning can sometimes result from a single large dose of lead, it usually is caused by months or years of exposure. Because lead cannot be seen, tasted, or smelled, people usually do not know when they are being exposed. Nearly everyone has some lead in his or her body.

Before its harmful effects were realized, lead was used in most gasolines, paints, water pipes, food and drink cans, and many other products. For example, house paint made before 1950 often contained as much as 50% lead. Paint manufactured up until 1978 still contained lead. As many as three-quarters of houses built before 1980 may have inside walls and woodwork painted with lead-based paint.²

Environmental regulations have reduced sources of lead pollution, significantly reducing lead in paint, gasoline, plumbing systems, and food and drink cans.⁹ However, lead does not break down, so any lead already present in soil or water will stay there unless it is physically removed.

The most common sources of lead poisoning are:¹

• Lead-based paint in houses or buildings built before 1978.
• Lead-soldered pipes, which contaminate water supplies.
• Working conditions, especially in mines, metal smelters, and radiator and battery shops.
• Soil that has been contaminated with lead from smelters, hazardous waste, or gasoline.
• Hobbies that involve lead, such as stained glass or pottery.
• Alternative medicines and supplements, such as some herbs and vitamins manufactured outside the United States.
• Cosmetics, such as facial powders made outside of the United States.
• Food that is stored in leaded crystal or in cans made with lead.
• Homemade liquor, especially in the southern United States, made in stills that are connected with lead solder. Between 20% and 90% of this "moonshine whiskey" contains dangerous levels of lead.³

A pregnant woman who is exposed to lead can pass it to her unborn baby.⁹ Lead can also be passed to a baby through the mother's breast milk.

A recent study focusing on children in an urban primary care clinic indicates that iron-deficient children absorb greater amounts of lead than children with adequate iron intake. Though further study on the subject is required, the results suggest that increasing iron intake in high-risk populations can help decrease the amount of lead absorbed by children in these groups.¹⁰

Lead poisoning usually does not cause symptoms until the level of lead in your blood is very high. Most lead poisoning comes from low levels of exposure over a long period of time. The major organ systems affected are the central nervous system, gastrointestinal (digestive) tract, and the renal system (urinary tract).

Chronic lead exposure may cause the following symptoms.

General physical symptoms in children and adults (usually seen when lead poisoning levels are severe)

• Stomachaches, cramping, constipation, or diarrhea
• Nausea, vomiting
• Persistent, unexplained fatigue
• Headache
• Muscle weakness
• Higher rates of tooth decay

Children with chronic low blood lead levels who may not have obvious symptoms of lead poisoning may have learning problems and be smaller in size than children their age who do not have low to moderate levels of lead poisoning. A recent study showed that declines in IQ can even be seen in children with blood lead concentrations below 10 micrograms of lead per deciliter of blood (10 mcg/dL), the level of concern defined by the U.S. Centers for Disease Control and Prevention and the World Health Organization.¹¹ Chronic exposure to lead may also cause behavioral problems in these children.

Behavioral symptoms in children

• Irritability or aggressiveness
• Hyperactivity, being easily distracted, impulsiveness
• Learning problems
• Lack of interest in play
• Loss of appetite

Behavioral symptoms in adults

• Irritability
• Unexplained changes in mood or personality
• Changes in sleep patterns
• Inability to concentrate
• Memory loss

Neurological symptoms (caused by effects of lead on the nervous system)

• Poor coordination
• Weakness in hands and feet
• Headaches
• Seizures
• Paralysis
• Coma

Diagnosing lead poisoning can be difficult because many other conditions cause similar symptoms.

Severe symptoms of acute lead poisoning can include seizures, unconsciousness, paralysis, or swelling in the brain. However, exposure to such a high level of lead is not common.¹ If you experience these symptoms, seek emergency medical care.

People are exposed to lead if they swallow or breathe lead-contaminated substances. Lead poisoning can be caused by a single large dose of lead, although it is usually the result of exposure to small amounts of lead over a long period of time.

Lead is slowly eliminated from the body in urine, bowel movements, and, to a very small extent, sweat. When the body is exposed to more lead than it can get rid of, it stores the extra lead in the blood, organs, bones, and teeth, and lead poisoning results. Lead can damage the kidneys, central nervous system (brain and spinal cord), and reproductive system, and cause high blood pressure. Lead is especially harmful to a child's developing brain.

Blood lead levels are measured in micrograms per deciliter (mcg/dL). There are different opinions among scientists and doctors on what is a safe level of lead in the blood. Lead has no known function in the body—its natural level in people before the industrial revolution in the 1800s and early 1900s was near zero.

Health effects of high blood lead levels in children

Children are more easily and significantly affected by high blood lead levels than adults.¹² High levels of lead in the blood are caused by lead poisoning. There are five classes of lead poisoning, according to the United States Centers for Disease Control and Prevention (CDC). These levels range from class 1 (less than 10 mcg/dL) to class 5 (a medical emergency of at least 70 mcg/dL).

Children who were exposed to lead before birth may be underweight and have low intelligence, attention-span problems, and other signs of nervous system damage.

A recent study showed that declines in IQ can be seen in children with blood lead concentrations below 10 mcg/dL, the level of concern defined by the U.S. Centers for Disease Control and Prevention and the World Health Organization.¹¹

Health effects of high blood lead levels in adults

High blood lead levels affect adults in several ways.¹²

• Blood lead levels above 10 mcg/dL may affect blood cell development.
• Blood lead levels above 40 mcg/dL can affect the function of:
  • The blood and the body's ability to form hemoglobin.
  • The nervous system, causing symptoms such as fatigue, irritability, memory loss, and slow reaction time.
  • The kidneys, causing chronic kidney disease and kidney failure.
  • The reproductive system, causing decreased sperm counts and increased numbers of abnormal sperm. Very high levels can cause miscarriage or stillbirth.
• High blood lead levels may also cause high blood pressure.

Unfortunately, people may not have noticeable symptoms until blood lead levels are high enough to cause serious damage to body systems.

Children

Age and environment determine a child's risk for lead poisoning. Young children who live in housing built prior to 1978 are at risk, and those living in homes built before 1950 are at greatest risk.^{13, 1} Recent or ongoing home renovation can also increase the risk of lead exposure if lead-based paint is being removed. Very young children are more likely to ingest lead by touching or playing in lead-contaminated soil or dust and then putting their hands in their mouths. They may also chew on or lick toys, jewelry, or woodwork, such as windowsills, painted with lead-based paint.

In 2007, the U.S. Consumer Product Safety Commission (CPSC) found high lead content in many children’s toys and jewelry made in other countries. For a complete list of recalled products, see the CPSC Web site at www.cpsc.gov.

Children who come from low-income families or who live in an inner-city environment are more likely to have high levels of lead in the blood because they are more likely to be exposed to lead-contaminated soil and dust or deteriorated paint in older housing. Children who are adopted from countries such as China where lead exposure is still a problem also may be more likely to develop lead poisoning.⁸

Babies, toddlers, and young children up to 6 years old are more likely to have problems from lead poisoning because of their:

• Behavior. Babies and toddlers explore their world by handling, mouthing, chewing, or tasting whatever they find, which may include paint chips or dirt with lead in it. Children also play close to the ground, where they may breathe in lead-contaminated dust.
• Growth stage. Babies and toddlers are easily affected because of their small body size and because their brains and bodies are growing and developing rapidly. In fact, children absorb 3 to 5 times as much lead as adults do.¹³

Inadequate iron intake is being studied for links to increased absorption of lead. It's possible that increasing iron intake in children at high risk for lead poisoning may slow the absorption of lead.¹⁰

Adults

The risk of lead poisoning for adults depends mostly on whether they have jobs or hobbies that involve exposure to lead. It may not always be obvious when there is lead in the workplace. For example, people who work in construction or do remodeling may inhale lead while scraping or sanding wood that has lead-based paint on it. People who work with lead can bring it home on their clothes, shoes, and hair, and expose others in the house. Adults may also be exposed to lead from cups or dishes with ceramic glazes or from natural or traditional remedies or supplements that contain lead. Some cosmetics manufactured outside of the United States also contain lead.

Consuming homemade liquor, especially "moonshine" made in the southern U.S. in stills that are connected with lead solder, greatly increases the risk of lead poisoning. Between 20% and 90% of this homemade liquor contains dangerous levels of lead.³

Call your doctor if you know or suspect that you or someone in your family has lead poisoning, has been exposed to lead, or has ingested a large dose of lead (for example, if your child eats any lead-contaminated paint chips).

Call 911 or other emergency services immediately if someone has convulsions or is unresponsive.

Call your doctor if you or someone else has either severe abdominal pain or frequent forceful, explosive vomiting usually not preceded by nausea (projectile vomiting).

Call your doctor if you live in an older home with peeling or chipping paint and someone in the house has any of the following symptoms:

• Fatigue or drowsiness
• Weakness of hands and feet
• Changes in personality
• Headaches

Call your health professional for advice if someone in your home has a job or hobby that involves the use of lead.

Chronic (long-lasting) lead poisoning often has no symptoms at all. See the Early Detection portion of the Exams and Tests section of this topic for guidelines on when to test someone for lead poisoning.

Watchful Waiting

Watchful waiting is not appropriate if you think that someone has lead poisoning. Call your health professional.

Who To See

Screening for lead poisoning is usually done by your regular family doctor. The following health professionals can order tests for blood lead levels:

• Pediatrician
• Family medicine doctor
• Internist
• General practitioner
• Nurse practitioner
• Physician assistant

Treatment for lead poisoning might be done by any of the health professionals above, by a doctor who specializes in the treatment of poisoning (toxicologist), or by a specialist in environmental and occupational medicine.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Diagnosing lead poisoning can be difficult, especially because its symptoms are so general. Lead poisoning may be diagnosed with a blood lead test that measures the amount of lead in the blood. This test does not measure the complete level of lead in the body, but it is the best test available at this time.

Results need to be reported to the local health department if 2 or more blood lead levels are above 10 micrograms per deciliter (mcg/dL). A home inspection is needed to find the source of the lead contamination.

Other tests that can be helpful if lead poisoning is suspected include:

• Complete blood count (CBC), to determine whether you have anemia, which can be caused by lead poisoning.
• Abdominal X-rays, which might show deposits of lead in the bowel.
• Extremity X-rays that may show lines of lead deposited in the bone, which may indicate chronic lead poisoning. See an illustration of an X-ray showing lead poisoning in a child's leg bones.
• BUN or creatinine tests, which check for kidney (renal) function problems that can be associated with lead poisoning.
• Urine test, which may be given to assess renal damage that might be associated with lead in the body.

Early Detection

Screening programs for lead poisoning check large numbers of children or adults who are likely to be exposed to lead. Screening tests done on 1 to 2 year olds have shown lead in the environment in most places. When children in an area no longer test positive for traces of lead, routine screening of those children is no longer needed. Screening programs in an area would need to be restarted only if something changed that would increase the risk for lead in that area.

Screening programs are set up by the U.S. Centers for Disease Control and Prevention (CDC) and give local and state agencies information to help find which areas are the most likely to be have high lead levels. Age of housing is an important factor in determining risk because older homes tend to have lead-based paint. If lead exposure is likely, then blood tests for infants and young children will be recommended to measure blood lead levels.

Individual screening can be done by your health professional. During a routine health exam, the risk for lead exposure can be evaluated by answering questions about family members' living and working conditions. The health professional may then decide whether blood lead levels should be measured.

Children

Children should be tested, no matter what their age, if they have been exposed to lead or if they have symptoms that could be caused by lead poisoning. Screening tests done on 1 to 2 year olds have shown lead in the environment in most places. When children in an area no longer test positive for traces of lead, routine screening of those children is no longer needed. Screening programs in an area would need to be restarted only if something changed that would increase the risk for lead in that area.

When children from a high risk area move into an area that does not have a high risk, their lead levels rapidly return to normal. The child's symptoms and the risk of exposure to lead in the new area should be considered when making decisions about screening these children.

The U.S. Preventive Services Task Force (USPSTF) does not recommend:¹⁴

• Lead poisoning testing for children ages 1 to 5 who don't have symptoms and do not have an increased risk.
• For or against routine testing in children ages 1 to 5 who have a greater risk for higher blood lead levels and don't have symptoms.

Many state and local health departments can provide information on screening recommendations in your area.

In addition, an individual child's risk for lead poisoning can be determined by answering a few screening questions.

Adults

The U.S. Occupational Health and Safety Administration (OSHA) requires companies to test the blood of employees who work with lead. OSHA sets industry standards to protect workers. For more information, contact OSHA, listed in the Other Places to Get Help section of this topic.

Adults who do not work with lead usually are not tested for lead poisoning. If you are pregnant or trying to become pregnant and you or a family member works with lead, you may want to ask your doctor about your risk for lead poisoning. The USPSTF does not recommend routine testing of blood lead levels in pregnant women who don't have symptoms.¹⁴

Treatment for lead poisoning begins with removing the sources of lead and providing balanced nutrition. These measures are usually sufficient to limit exposure to lead and reduce lead levels in the body.

Old paint chips and dirt are the most common sources of lead in the home. Lead-based paint and the dust and dirt that come from its decomposition should be removed by professionals. In the workplace, removal of sources usually involves removing lead dust that is in the air, as well as making sure adults don't bring contaminated dust or dirt into the home on clothes worn for work.

Balanced nutrition includes adequate amounts of vitamins and minerals such as iron, calcium, and vitamin C. A person who eats a balanced, nutritious diet absorbs less lead than a person whose diet is inadequate.

If removing the source of lead and balancing nutrition do not reduce lead levels, or if the blood lead level is very high, chelation therapy may be used. Chelation therapy is a process that rapidly reduces the amount of lead stored in the body. Drugs called chelating agents cause metals like lead to bind to them, and then they are eliminated from the body through urine. Because chelating agents increase the absorption of lead and other metals, it is essential that sources of lead exposure be removed before a person is treated.

If blood lead levels do not come down with treatment, the home and work areas need to be rechecked for other sources of lead. Contact your local health department to see what inspection services are available in your area.

Prevention, primarily through screening of both children and adults, is the most effective means of reducing or eliminating the effects of lead poisoning. Damage from lead poisoning, especially to the central nervous system, is often incurable and may not improve with treatment.

Lead poisoning may be prevented or limited by removing the source of lead in your home or workplace and by eating a healthful, balanced diet.

The most common sources of lead are lead-based paint and lead in dust or soil. Peeling or chipped paint is easily crushed into dust in the home or into the soil around the house. Older, industrial buildings may have been painted with lead-based paint. When these buildings are remodeled, dust containing dangerous levels of lead can contaminate the air and soil. Houses built before 1978 probably have some amount of lead-based paint, and homes built prior to 1950 often have the highest level of lead-based paint.

Lead paint can be found on some toys, too. In 2007, the U.S. Consumer Product Safety Commission (CPSC) found high lead content in many children’s toys and jewelry made in other countries. For a complete list of recalled products, see the CPSC Web site at www.cpsc.gov.

Levels of lead in the blood can be reduced through regular housecleaning by crews trained to reduce leaded dust on surfaces.¹⁵ Cleaning includes wet-mopping floors, damp sponging of walls and counters, and vacuuming with a high-efficiency vacuum.

If you want the paint in your home tested for lead, call your local or state health department. They may do it for you or give you the names of companies experienced in doing such tests. Home test kits may not be accurate.

Other sources of lead include:

• Renovation, remodeling, or repainting of older homes.
• Jobs or hobbies that involve exposure to lead.
• Certain traditional or natural medicines or cosmetics (such as surma, also called kohl, used in some mascara).
• Leaded crystal or lead-glazed pottery.
• Food, such as vegetables grown in lead-contaminated soil or food from lead-soldered cans. Some cans not manufactured in the United States may have lead soldering.
• Water from faucets in homes with lead or lead-soldered copper pipes.
• Polluted air, particularly near lead smelters or other industries that use lead.
• Some "natural" remedies or supplements, such as some herbs or vitamins from India.⁴
• Some printing materials, such as ink used in print on plastic bags.
• Some vinyl plastic items, such as mini-blinds manufactured outside the U.S. before 1996.

Certain measures can prevent or reduce exposure to lead. If you have lead in your house paint, soil, or drinking water, you may want to consider the following:

• Tips if your home is contaminated, such as wiping toys, windowsills, door frames, and uncarpeted floors with a wet cloth or damp mop twice a week with warm, soapy water.
• Tips if your drinking water is contaminated, including letting cold water run for a few minutes in the morning before using it for drinking or cooking.
• Tips for nutrition and food preparation, including making sure children get enough iron in their diet.
• Tips if you have a job or hobby that involves working with lead, such as showering and changing clothes and shoes at work before getting in your car or before you come home, to prevent bringing home lead dust on your clothes and hair.

Ensuring balanced nutrition may prevent or reduce lead poisoning. People who get enough vitamin C, iron, zinc, calcium, and phosphorus are less likely to absorb lead than are people who have inadequate diets. Frequent meals or snacks help prevent lead poisoning, because lead is not as easily absorbed on a full stomach. People who eat high-fat diets absorb more lead, as do people with iron deficiency.

If you suspect that someone in your family has lead poisoning, consult a health professional immediately. The most important thing you can do is remove sources of lead in and around your home.

If you have lead in your house paint, soil, or drinking water, you may want to consider the following:

• Tips if your home is contaminated, such as wiping toys, windowsills, door frames, and uncarpeted floors with a wet cloth or damp mop twice a week with warm, soapy water.
• Tips if your drinking water is contaminated, including letting cold water run for a few minutes in the morning before using it for drinking or cooking.
• Tips for nutrition and food preparation, including making sure children get enough iron in their diet.
• Tips if you have a job or hobby that involves working with lead, such as showering and changing clothes and shoes at work before getting in your car or before you come home, to prevent bringing home lead dust on your clothes and hair.

Good nutrition is important. Make sure your family eats a diet that includes adequate amounts of vitamins and minerals such as iron, calcium, and vitamin C.

Chelating agents are used for severe lead poisoning. Chelating agents are medicines that bind with lead in blood and both soft and bony tissues and eliminate it quickly from the body, usually through the urine.

The use of chelating agents for lead poisoning is still being studied, and there is no single treatment or drug of choice. In general, drug treatment is recommended when blood lead levels are above 45 micrograms per deciliter (mcg/dL) or when there are symptoms of lead poisoning, especially lead encephalopathy.

There is disagreement over whether chelation therapy is needed for children with blood lead levels between 25 mcg/dL and 44 mcg/dL—one study showed no benefit to the child.¹⁶ Reducing or removing environmental lead sources, correcting iron deficiency, and improving nutrition may be enough to lower lead levels in the blood. The decision to use chelating agents depends on how long the child has been exposed to lead, how high the blood lead level is, what the symptoms are, and whether the blood lead level remains high even after the source of lead is removed or reduced and nutrition is improved.

In theory, chelating agents prevent further damage by reducing blood lead levels rapidly. Damage to the blood may repair itself if blood lead levels are lowered. Kidney damage may also heal, unless it has been too extensive. Chelation therapy may not reverse central nervous system (brain and spinal cord) damage that has already occurred.

Medication Choices

Chelating agents are chemicals that bind with lead for the treatment of lead poisoning.

What To Think About

Chelating agents increase absorption of lead and other metals. A person exposed to lead while taking a chelating agent may absorb more of the lead, thus defeating the purpose of the therapy and possibly doing even more harm. Therefore, it is essential that lead sources be removed from your environment before treatment. (This may require that treatment be administered in a hospital.) Do not return home or to the workplace until lead sources have been removed.

Results need to be reported to the local health department if 2 or more blood lead levels are above 10 micrograms per deciliter (mcg/dL). A home inspection is needed to find the source of the lead contamination.

If blood lead levels do not come down with treatment, your home and work areas need to be rechecked for other sources of lead. Contact your local health department to see what inspection services are available in your area.

Iron deficiency also increases lead absorption. Iron deficiency cannot be treated at the same time as chelation therapy because the chelating drug will bind to iron and remove it as well. Iron deficiency must be treated either before or after chelation therapy.

Chelation therapy does reduce blood lead levels and may slow down problems with kidney function associated with lead poisoning.¹⁷ However, it does not appear to improve cognitive damage or other neurological problems already caused by the lead poisoning.¹⁶ If chelation therapy is necessary, it is best to consult with a doctor experienced with this treatment.

There is no surgical treatment for lead poisoning.

Studies are ongoing to determine whether ascorbic acid can help treat lead poisoning by reducing blood lead levels.¹⁸ Ascorbic acid is found naturally in citrus fruit, tomatoes, potatoes, and leafy vegetables. However, initial studies indicate that ascorbic acid must be injected into the blood to decrease levels of lead in the blood. Eating fruits or vegetables that contained ascorbic acid was not helpful.

There is currently no other proven medical treatment for lead poisoning.

Organizations

• Early Disease Detection
• Environmental Illness
• Health and Safety, Ages 2 to 5 Years
• Health and Safety, Birth to 2 Years
• Nervous System Problems
• Poisoning

Citations

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5. U.S. Centers for Disease Control (2005). Blood lead levels—United States, 1999–2002. MMWR, 54(20): 513–516.

6. Needleman HL (2002). Management of lead toxicity. In FD Burg et al., eds., Gellis and Kagan's Current Pediatric Therapy, 17th ed., pp. 1051–1052. Philadelphia: W.B. Saunders.

7. Friedrich MJ (2000). Poor children subject to "environmental injustice." JAMA, 283(23): 3057–3058.

8. Aronson JE, et al. (2000). Elevated blood lead levels among internationally adopted children—United States, 1998. JAMA, 283(11): 1417–1418.

9. Long H, Nelson LS (2004). Metals and metalloids. In JE Tintinalli et al., eds., Emergency Medicine, 6th ed., pp. 1146–1153. New York: McGraw-Hill.

10. Wright RO, et al. (2003). Association between iron deficiency and blood lead level in a longitudinal analysis of children followed in an urban primary care clinic. Journal of Pediatrics, 142: 9–14.

11. Canfield RL, et al. (2003). Intellectual impairment in children with blood lead concentrations below 10 µg per deciliter. New England Journal of Medicine, 348(16): 1517–1526.

12. Shannon MW (1998). Lead. In LM Haddad et al., eds., Clinical Management of Poisoning and Drug Overdose, 3rd ed., pp. 767–783. Philadelphia: W.B. Saunders.

13. Centers for Disease Control and Prevention (2000). Recommendations for blood lead screening of young children enrolled in Medicaid: Targeting a group at high risk. MMWR, 49(RR-14): 1–13.

14. U.S. Preventive Services Task Force (2006). Screening for elevated blood lead levels in children and pregnant women. Available online: http://www.ahrq.gov/clinic/uspstf/uspslead.htm.

15. Rhoads GC, et al. (1999). The effect of dust lead control on blood lead in toddlers: A randomized trial. Pediatrics, 103(3): 551–555.

16. Rogan WJ, et al. (2001). The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. New England Journal of Medicine, 344(19): 1421–1471.

17. Lin JL, et al. (1999). Chelation therapy for patients with elevated body lead burden and progressive renal insufficiency. Annals of Internal Medicine, 130: 7–13.

18. Simon JA, Hudes ES (1999). Relationship of ascorbic acid to blood lead levels. JAMA, 281(24): 2289–2293.

Other Works Consulted

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Author:	Sydney Youngerman-Cole, RN, BSN, RNC	Last Updated: July 26, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics R. Steven Tharratt, MD, MPVM, FACP, FCCP - Pulmonology, Critical Care, Medical Toxicology
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