Lead poisoning

Definition

Lead is a very strong poison. When a person swallows a lead object or breathes in lead dust, some of the poison can stay in the body and cause serious health problems.

Alternative Names

Plumbism

Where Found

Lead used to be very common in gasoline and house paint in the U.S. Children living in cities with older houses are more likely to have high levels of lead.

Although gasoline and paint are no longer made with lead in them, lead is still a health problem. Lead is everywhere, including dirt, dust, new toys, and old house paint. Unfortunately, you can't see, taste, or smell lead.

Lead is found in:

• House paint before 1978. Even if the paint is not peeling, it can be a problem. Lead paint is very dangerous when it is being stripped or sanded. These actions release fine lead dust into the air. Infants and children living in pre-1960's housing (when paint often contained lead) have the highest risk of lead poisoning. Small children often swallow paint chips or dust from lead-based paint.
• Toys and furniture painted before 1976.
• Painted toys and decorations made outside the U.S.
• Lead bullets, fishing sinkers, curtain weights.
• Plumbing, pipes, and faucets. Lead can be found in drinking water in homes containing pipes that were connected with lead solder. Although new building codes require lead-free solder, lead is still found in some modern faucets.
• Soil contaminated by decades of car exhaust or years of house paint scrapings. Lead is more common in soil near highways and houses.
• Hobbies involving soldering, stained glass, jewelry making, pottery glazing, and miniature lead figures (always look at labels).
• Children's paint sets and art supplies (always look at labels).
• Pewter pitchers and dinnerware.
• Storage batteries.

Children get lead in their bodies when they put lead objects in their mouths, especially if they swallow the lead object. They can also get lead poison on their fingers from touching a dusty or peeling lead object, and then putting their fingers in their mouths or eating food afterward. Children also can breathe in tiny amounts of lead.

Symptoms

There are many possible symptoms of lead poisoning. Lead can affect many different parts of the body. A single high dose of lead can cause severe emergency symptoms.

However, it is more common for lead poisoning to build up slowly over time. This occurs from repeated exposure to small amounts of lead. In this case, there may not be any obvious symptoms. Over time, even low levels of lead exposure can harm a child's mental development. The health problems get worse as the level of lead in the blood gets higher.

Lead is much more harmful to children than adults because it can affect children's developing nerves and brains. The younger the child, the more harmful lead can be. Unborn children are the most vulnerable.

Possible complications include:

• Behavior or attention problems
• Failure at school
• Hearing problems
• Kidney damage
• Reduced IQ
• Slowed body growth

The symptoms of lead poisoning may include:

• Abdominal pain and cramping (usually the first sign of a high, toxic dose of lead poison)
• Aggressive behavior
• Anemia
• Constipation
• Difficulty sleeping
• Headaches
• Irritability
• Loss of previous developmental skills (in young children)
• Low appetite and energy
• Reduced sensations

Very high levels of lead may cause vomiting, staggering walk, muscle weakness, seizures, or coma.

Home Care

You can reduce exposure to lead with the following steps:

• If you suspect you may have lead paint in your house, get advice on safe removal from the Housing and Urban Development (HUD) at 800-RID-LEAD or the National Information Center at 800-LEAD-FYI. Another excellent source of information is the National Lead Information Center at (800) 424-5323.
• Keep your home as dust-free as possible.
• Have everyone wash their hands before eating.
• Throw out old painted toys if you do not know whether the paint contains lead.
• Let tap water run for a minute before drinking or cooking with it.
• If your water has tested high in lead, consider installing an effective filtering device or switch to bottled water for drinking and cooking.
• Avoid canned goods from foreign countries until the ban on lead soldered cans goes into effect.
• If imported wine containers have a lead foil wrapper, wipe the rim and neck of the bottle with a towel moistened with lemon juice, vinegar, or wine before using.
• Don't store wine, spirits, or vinegar-based salad dressings in lead crystal decanters for long periods of time, because lead can get into the liquid.

Before Calling Emergency

Try to identify the following information:

• The patient's age, weight, and condition
• The name of the product or the object you think had lead in it
• The date/time the lead was swallowed or inhaled
• The amount swallowed or inhaled

Poison Control

If someone has severe symptoms from possible lead exposure (such as vomiting or seizures) call 911 immediately.

For other symptoms that you think may be caused by lead poisoning, call your local poison control center.

In the United States, call 1-800-222-1222 to speak with a local poison control center. This hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

What to Expect at the Emergency Room

Except in severe cases where someone has received a high dose of lead, a trip to the emergency room is not necessary. Contact your health care provider or department of public health if you suspect possible low-level lead exposure.

A blood lead test can help identify whether a problem exists. Over 10 micrograms per deciliter (mcg/dL) is a definite concern. Levels between 2- 10 mcg/dL should be discussed with your doctor. In many states, blood screening is recommended for young children at risk.

Other lab tests may include:

• Bone marrow biopsy
• Complete blood count (CBC) and coagulation studies
• Erythrocyte protoporphyrin
• Iron level
• X-ray of the long bones and abdomen

For children whose blood levels of lead are moderately high, the steps are to identify all major sources of lead exposure and keep the child away from them. Follow-up blood testing may be needed.

Chelation therapy is a procedure that can remove high levels of lead that have built up in a person's body over time.

In cases where someone has potentially eaten a high toxic dose of lead in a short period of time, the following treatments might be done:

• Bowel irrigation with polyethylene glycol solution
• Gastric lavage

Outlook (Prognosis)

Adults who have had mildly high lead levels often recover without problems. In children, even mild lead poisoning can have a permanent impact on attention and IQ.

People with higher lead levels have a greater risk of long-lasting health problems. They must be followed carefully.

Their nerves and muscles can be greatly affected and may no longer function as well as they should. Other body systems may be harmed to various degrees, such as the kidneys and blood vessels. People who survive toxic lead levels may have some permanent brain damage. Children are more vulnerable to serious long-term problems.

A complete recovery from chronic lead poisoning may take months to years.

References

Woolf AD, Goldman R, Bellinger DC. Update on the clinical management of childhood lead poisoning. Pediatr Clin North Am. 2007;54:271-294.

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