Lead is a metal that people used for thousands of years. It is used in paints, batteries, plumbing materials, and leaded gasoline. However, lead is hazardous and can cause severe health problems, including cardiovascular, nervous, kidney, and reproductive system problems, particularly in children.
Adult lead poisoning is mostly caused by inhalation exposure in the workplace.1 Paediatric lead poisoning is caused primarily by lead intake via environmental media like as paint chips, dust, soil, drinking water, ceramics, and medications.1 Over time, lead accumulation in the body causes lead poisoning, also known as plumbism.
The causes, symptoms, diagnosis, management, and treatment of lead poisoning are covered in this article.
Causes of lead poisoning
Lead poisoning can develop from a variety of causes. Here are some common causes of lead poisoning:
- Lead-based paint:
This is one of the most common forms of lead exposure, especially in older homes. Lead was widely used in paint until it was banned in several countries.2 Homes built before the 1970s may still have lead-based paint on the walls, windows, and doors. When paint deteriorates or is disturbed during renovation or repainting, lead dust or chips can be inhaled or ingested.
- Contaminated soil:
Contamination can occur from various sources, including paint residues, industrial activity, and previous use of leaded petrol.2 Children who play on lead-contaminated soil may consume it.
- Drinking water:
Lead can enter drinking water via corroded lead pipes, plumbing fixtures, or solder used in plumbing systems.2 Homes with old plumbing systems may be more vulnerable to lead-contaminated drinking water.
- Toys, jewellery, cosmetics, and pottery are examples of imported goods that may include lead-based paints, dyes, or glazes. Lead exposure is possible when these items are regularly mouthed, chewed, or touched.
- Working with or around lead-containing materials can be dangerous in jobs like battery production, lead smelting, building, and painting. Workers in these fields may be exposed to lead poisoning if sufficient safety precautions are not taken.
Signs and symptoms of lead poisoning
Developmental and neurological symptoms:1,4
- In children - delayed speech, language disabilities, learning issues
- Behaviour and mood changes (e.g., irritation, hyperactivity)
- Reduced concentration span
- Cognitive disability, lower IQ
- Memory lapses
- sleep disruptions
Symptoms of the gastrointestinal tract:4
- Pain in the abdomen
- Vomiting and nausea
- Appetite loss
- Anaemia (inadequate red blood cell count)
- Weakness and fatigue
- Skin tone is light
Symptoms of Renal Failure:1,4
- High blood pressure
- Kidney damage
- Urine production changes (increased or reduced)
- Fertility problems in both men and women
- Miscarriages or stillbirths
- Premature delivery
- Low birth weight
- Delayed sexual development
- Metallic taste in the mouth
- Joint and muscle pain
- Tingling/numbness in extremities
Management and treatment for lead poisoning
Initially, a source of lead exposure should be determined and eliminated.3 Potential sources must be tested for lead levels. Including the removal of lead-based paint, the replacement of lead pipes, and the reduction of exposure to contaminated soil or dust.5
Patients who have ingested foreign bodies should be monitored for foreign body passage and given laxatives or cathartics if necessary to help the object move. Those who have had significant ingestions may require whole-bowel irrigation.3 Those who have retained lead bullets may consider surgery.3
Supportive care is critical for the affected individual's overall health. This may include providing a diet high in iron, calcium, and vitamin C, as these nutrients help reduce lead absorption and promote recovery.3 Maintaining appropriate hygiene, such as frequent handwashing and clean living conditions, can also help to reduce long-term exposure.3
Chelation therapy is done with a drug that binds lead in the body, helping it to be eliminated in the urine. It is usually done during severe lead poisoning or exceptionally high blood lead levels. Children whose blood lead concentrations are more than 45 mcg/dL, adults with more than 70 to 100 mcg/dL, or any patient with lead encephalopathy (usually accompanied by a significantly elevated blood lead concentration) should receive chelation therapy under the supervision of health professionals.5,6 Depending on the severity of the clinical presentation and the patient's blood lead level, a range of chelating drugs, including succimer, can be given alone or in combination.3
As lead toxicity is more prevalent in older urban areas, paediatric screening guidelines for lead vary by country.7 It is suggested that all children aged 3 to 5 should be screened at least once. Furthermore, the Occupational Safety and Health Administration (OSHA) mandates employers to undertake medical monitoring (i.e., lead screening) for any employee who may be exposed to airborne lead concentrations exceeding 30 mg/minute for more than eight hours daily for more than 30 days per year.6 Capillary blood is used for screening as it is faster and easier to test, afterwards elevated results from capillary blood (i.e., more than 5 mcg/dL) should be confirmed with a blood venous sample. Additional screening labs to measure iron status and anaemia are required in patients with a confirmed increased whole blood venous lead, and an abdominal X-ray should be considered if the patient has consumed a lead-containing foreign body. A complete exposure history should be requested in the event of lead exposure, with special attention devoted to occupation and hobbies, home environment (for example, the age of the home, any recent renovations or repairs), and food and water supplies.5,6
How can I prevent lead poisoning?
To avoid lead poisoning, identify and eliminate potential lead sources such as lead-based paint, contaminated water, and imported goods with high lead content. Maintain lead-free living environments by cleaning surfaces regularly and drinking cold tap water. Encourage a nutritious diet high in calcium, iron, and vitamin C and breastfeeding. Wash your hands properly and frequently, especially before eating, to practise excellent hygiene. When purchasing imported goods, be sure they fulfil lead safety regulations. Make a safe play environment for children by using lead-free toys and inspecting play spaces regularly. Keep up to date on lead safety rules and seek expert assistance if you have any concerns or fear you have been exposed.
How common is lead poisoning?
Lead poisoning is an important public health concern, especially in developing countries. Its prevalence varies according to factors such as geographical location, socioeconomic situations, and exposure sources.
The World Health Organisation (WHO) estimated that lead exposure causes around 1.06 million deaths and 24.4 million years of healthy life to be lost globally due to its long-term health impacts.
Who is at risk of lead poisoning?
Several groups are more vulnerable to lead poisoning. Children under the age of six are especially at risk due to their developing bodies and behaviour that may involve hand-to-mouth contact. Pregnant women can pass lead to their unborn children, potentially causing developmental difficulties. Construction, battery manufacture, and painting are all jobs that expose workers to lead or lead-containing materials if safety precautions are not taken. People who live in older homes with lead-based paint or in industrial regions with potential lead poisoning are also at risk. Furthermore, persons in areas with poor infrastructure, regulations, and monitoring may be in greater danger.
What can I expect if I have lead poisoning?
Fatigue, abdominal pain, loss of appetite, weight loss, memory loss, irritability, and headaches are common symptoms. Children can have developmental delays, behavioural issues, and medical symptoms such as gastrointestinal pain and constipation. Seizures, comas, and death can occur in severe situations. When do the symptoms of lead poisoning appear?
Symptoms might vary based on the level and duration of exposure. If you suspect lead poisoning, seek medical assistance immediately to receive appropriate testing, treatment, and support for managing the disease.
When should I see a doctor?
You should consult a doctor if you suspect you have been exposed to lead or have any lead poisoning symptoms. Furthermore, if your work exposes you to lead or you live in an older home with lead-based paint, you should visit a doctor. Early medical intervention is critical for properly diagnosing, treating, and managing lead poisoning.
Lead poisoning is caused by the accumulation of high quantities of lead in the body over time. Lead can be present in a variety of places, including lead-based paints, contaminated water, soil, dust, and some items. When lead is swallowed or inhaled, it can harm several biological systems, most notably the neurological system, kidneys, and blood. Lead poisoning can be harmful, particularly to children, causing developmental delays, learning difficulties, behavioural issues, and long-term health repercussions. Early detection, prevention, and care are critical in reducing the negative effects of lead poisoning and protecting general health.
- Landrigan PJ, Todd AC. Lead poisoning. West J Med [Internet]. 1994 Aug [cited 2023 Sep 18];161(2):153–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1022528/
- Olufemi AC, Mji A, Mukhola MS. Potential health risks of lead exposure from early life through later life: implications for public health education. Int J Environ Res Public Health [Internet]. 2022 Nov 30 [cited 2023 Sep 18];19(23):16006. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741093/
- Halmo L, Nappe TM. Lead toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jul 13]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541097/
- Wani AL, Ara A, Usmani JA. Lead toxicity: a review. Interdiscip Toxicol [Internet]. 2015 Jun [cited 2023 Jul 13];8(2):55–64. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961898/
- COUNCIL ON ENVIRONMENTAL HEALTH, Lanphear BP, Lowry JA, Ahdoot S, Baum CR, Bernstein AS, et al. Prevention of childhood lead toxicity. Pediatrics [Internet]. 2016 Jul 1 [cited 2023 Nov 24];138(1):e20161493. Available from: https://publications.aap.org/pediatrics/article/138/1/e20161493/52600/Prevention-of-Childhood-Lead-Toxicity
- Kosnett MJ, Wedeen RP, Rothenberg SJ, Hipkins KL, Materna BL, Schwartz BS, et al. Recommendations for medical management of adult lead exposure. Environ Health Perspect [Internet]. 2007 Mar [cited 2023 Sep 18];115(3):463–71. Available from: https://ehp.niehs.nih.gov/doi/10.1289/ehp.9784
- Wengrovitz AM, Brown MJ, Advisory Committee on Childhood Lead Poisoning, Division of Environmental and Emergency Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention. Recommendations for blood lead screening of Medicaid-eligible children aged 1-5 years: an updated approach to targeting a group at high risk. MMWR Recomm Rep. 2009 Aug 7;58(RR-9):1–11. Available from: https://pubmed.ncbi.nlm.nih.gov/19661858/