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What is lead poisoning?

Lead poisoning is a preventable condition that results from environmental exposure to lead. This exposure, indicated by elevated blood lead levels, can result in permanent health damage, especially among children. At very high levels, lead poisoning can be fatal.

According to the Centers for Disease Control and Prevention (CDC), more than half a million children in the United States between the ages of 1 and 5 years have blood lead levels greater than 5 micrograms per deciliter (mcg/dL). This is the reference blood lead level that the CDC currently considers to be unsafe. It should be noted that, according to the CDC, no safe blood lead level in children has been identified.

Lead is a soft, corrosion-resistant metal that is present in small quantities throughout the environment. Prior to 1978, it was a major ingredient in household paints and gasoline, used in water pipes, used to solder canned foods, and put into pesticides that were used in orchards. While these uses have been banned in the United States and lead is much more carefully controlled, it is still used in more than 100 industries and a variety of hobbies.

Small particles of lead enter the body primarily through inhalation or ingestion of lead-laden dust. From the lungs or intestinal tract, the lead travels to the bloodstream and organs throughout the body. The body then gradually moves lead from the blood and organs to the bones and teeth, where it may be stored for decades. About 94% of the lead in adults and 73% of that in children is eventually stored in the bones. To rid itself of lead, the body slowly takes it back out of the bones and excretes it in the urine and stool. Lead can also sometimes re-mobilize, moving back into the blood and organs when a bone is broken or during pregnancy. It can be passed from a mother to her unborn child and to an infant during breastfeeding. Women whose fetuses are exposed to lead may miscarry or have a premature delivery.

Accordion Title
About Lead Poisoning
  • Risk Factors for Lead Exposure

    The degree to which a person is affected by exposure to lead depends on their age, the amount and time of exposure, and their own health and nutritional state. Those who are iron deficient or malnourished, for instance, are more vulnerable to increased lead absorption.

    When a pregnant woman is exposed to lead, her child is at increased risk for growth delays and learning difficulties.

    Infants and young children who are exposed to lead are at increased risk for:

    • Developmental delays
    • Learning difficulties
    • Irritability/mood changes
    • Loss of appetite
    • Weight loss
    • Sluggishness and fatigue
    • Abdominal pain
    • Vomiting
    • Constipation
    • Hearing loss


    Children younger than 6 years of age are the most likely to be exposed to lead because they often put their hands in their mouth. The lead gets into their bodies by their ingesting lead dust or paint chips, inhaling dust, mouthing or chewing items that contain lead or have been contaminated by lead, and by eating contaminated food or drinking contaminated water.

    Housing built prior to 1978 may contain lead-based paint and lead-contaminated household dust. Soil surrounding these houses may also be contaminated with lead and be a source of exposure.

    Adult lead exposure is usually related to occupational or recreational (hobby) exposure. Children and spouses of those who work with lead may become exposed when lead contamination is brought home on the work clothes of the employee.

    Work settings where lead exposure is possible

    • Lead smelting
    • Construction work
    • Steel welding
    • Bridge reconstruction
    • Firing range instruction and cleaners
    • Remodeling and refinishing
    • Foundry work
    • Scrap metal recycling
    • Auto repair work
    • Cable splicing


    Hobbies where lead exposure is possible

    • Casting bullets or fishing sinkers
    • Remodeling a home built before 1978
    • Target shooting at firing ranges
    • Lead soldering
    • Auto repair work
    • Stained glass work
    • Glazed pottery work
    • Painting with artistic pigments
    • Distilling liquor ("moonshine") in lead vessels


    Some traditional or folk remedies, health foods, nutritional supplements, cosmetics, costume jewelry, toys, and canned foods imported from other countries may contain lead. Healthcare practitioners should consider screening people, especially children, who are immigrants, refugees, or who are adopted from other countries as they are at an increased risk for excessive lead exposure.

  • Signs and Symptoms

    Lead poisoning can affect many different parts of the body. A single high dose of lead can cause severe symptoms, coma, and even death. However, it is more common for lead to build up in the body slowly as a result of repeated exposure to small amounts of lead. When this occurs, there may not be any obvious symptoms, but health problems get worse as the level of lead in the blood increases.

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

      In adults, the signs and symptoms of lead poisoning may include:

      • High blood pressure
      • Abdominal pain
      • Constipation
      • Joint and/ or muscle pains
      • Declines in mental function
      • Pain, numbness, or tingling in the extremities
      • Headaches
      • Memory loss
      • Mood disorders
      • Reduced sperm count/abnormal sperm
      • Miscarriage or premature birth in pregnant women


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

    • Tests

      A blood lead test can be done to determine the level of lead in the body. This is usually performed on a sample drawn from a vein in the arm but may sometimes be performed on a sample from a fingerstick or heelstick (for infants). If the fingerstick sample is abnormal, then it is frequently followed by a sample taken from a vein in the arm to confirm the findings. Blood lead levels are a snapshot of the amount of lead in the blood at that moment. They are the best test for detecting and evaluating recent acute and chronic exposure. Blood lead samples are used to screen for exposure and to monitor the effectiveness of treatment.

      If a child's blood lead level is greater than 20 mcg/dL, the healthcare practitioner may order a hemoglobin and/or hematocrit test to determine if the child is anemic and may order iron tests to check for iron deficiency.

      In adults, the zinc protoporphyrin (ZPP) test may be ordered, along with a lead level, to test for chronic lead exposure. Hobbyists who work with products containing lead and people who live in older houses may be at an increased risk of developing lead poisoning. In an industrial setting, the Occupational Safety & Health Administration (OSHA) mandates the use of the ZPP test and strongly recommends that a ZPP test be ordered every time that a lead level is ordered to monitor an employee's exposure to lead. Both are necessary because ZPP will not reflect recent or acute lead exposure and it does not change quickly when a person's source of lead exposure is removed. ZPP is best at detecting a person's average exposure to lead over the last 3-4 months. ZPP is not sensitive enough for use as a lead screening test in children, as values do not rise until lead concentrations exceed the acceptable range.

    • Treatment

      The best way to deal with lead is to avoid lead exposure in the first place. The number of people in the United States who have elevated blood lead levels has decreased dramatically since lead was eliminated from house paints, gasoline, water pipes, and other household products, and because of the close monitoring of lead in industry.

      Screening of children and occupational screening of adults is used to identify and guide treatment of lead poisoning. The most common treatment is to identify the source of the lead and eliminate or minimize further exposure. This may include measures such as wet mopping living areas frequently and flushing water from the tap before drinking if lead pipes are used. Lead abatement of a house may be necessary in some cases. This is the process of methodically removing lead paint or other lead sources from a building or area and is usually performed by a trained professional. Do not attempt to remove lead-based paint yourself – you are likely to endanger yourself and your family.

      Children

      When a child's blood lead level is greater than or equal to 5 micrograms per deciliter (mcg/dL) but less than 45 mcg/dL, the Centers for Disease Control and Prevention (CDC) recommends that the child's parents or guardians be educated about the dangers of lead exposure and the child's home and other places where the child spends time should be examined for a source of lead. Once identified, the source of the lead must be removed from the child's environment and the child's blood lead level re-tested.

      For children with blood lead levels greater than 45 but less than 70 mcg/dL, the CDC recommends chelation therapy. Chelation therapy is a treatment that rids the body of lead by introducing agents to which lead binds and is then carried out of the body in the urine.

      Lead levels greater than 70 mcg/dL are considered a medical emergency. Children will be hospitalized and receive aggressive chelation therapy. In this case, chelation therapy involves administration of the drugs dimercaprol (also known as BAL) and CaNa2-EDTA.

      Adults

      Adults can tolerate higher blood levels than children. If they have occupational lead levels greater than 40 mcg/dL, OSHA requires that they be removed from further lead exposure and transferred to a low-lead job (called medical removal) until their lead level drops to a lower level. If several workers have significantly elevated lead levels and/or excessive levels persist, then lead abatement at the work site may be required.

      When an adult exhibits signs and symptoms of a neurologic disorder (encephalopathy) due to lead exposure or when blood lead levels exceed 100 µg/dL, the CDC recommends chelation therapy.

    View Sources

    NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

    Sources Used in Current Review

    Centers for Disease Control and Prevention. Blood Lead Levels in Children Aged 1-5 Years – United States, 1990-2010. MMWR. April 5, 2013. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6213a3.htm. Accessed on September 30, 2015.

    Centers for Disease Control and Prevention. CDC Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations. June 7, 2012. PDF available for download at http://www.cdc.gov/nceh/lead/ACCLPP/CDC_Response_Lead_Exposure_Recs.pdf. Accessed on September 30, 2015.

    Centers for Disease Control and Prevention. (2014 19 June, Updated.) Blood Lead Levels In Children. Available online at http://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm. Accessed on September 30, 2015.

    Centers for Disease Control and Prevention. (2014 19 June, Updated.) Lead Home: Prevention Tips. Available online at http://www.cdc.gov/nceh/lead/tips.htm. Accessed on September 30, 2015.

    Centers for Disease Control and Prevention. (2014 19 June, Updated.) Lead Home: CDC's Childhood Lead Poisoning Prevention Program. Available online at http://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm. Accessed on September 30, 2015.

    Kathuria, P Rowden, A and O'Malley RK. (2015 22 September, Updated). Lead Toxicity. Available online at http://emedicine.medscape.com/article/1174752-overview. Accessed on October 2, 2015.

    Mayo Clinic Staff. (2014 10 June, Updated.) Lead Poisoining. Available online at http://www.mayoclinic.org/diseases-conditions/lead-poisoning/basics/definition/con-20035487. Accessed September 30, 2015.

    US National Library of Medicine. (2013 1 February, Updated.) Lead Poisoning. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/002473.htm. Accessed September 30, 2015.

    Agency for Toxic Substances & Disease Registry. (2014 21 October, Updated.) Medical Management Guidelines for Lead (Pb). PDF available to download at http://www.atsdr.cdc.gov/MHMI/mmg13.pdf. Accessed October 2, 2015.

    Dietrich, KN Ware, JH, Salganik, M, et al. Effect of Chelation Therapy on Neuropsychological and Behavioral Development of Lead-exposed Children After School Entry. Pediatrics. 2004; 114(1):19-26 (ISSN: 1098-4275).

    National Poison Control Center. Chelation: Therapy or "Therapy"? Available online at http://www.poison.org/articles/2011-mar/chelation-therapy. Accessed on October 2, 2015.

    Regulations (Standards - 29 CFR), Medical Surveillance Guidelines - 1926.62 App C. U.S. Department of Labor, Occupational Safety & Health Administration (OSHA) [Current on-line Regulation Standard for Lead Exposure]. Available online https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10644.

    Sources Used in Previous Reviews

    Phone interview with Ray Meister, Occupational Health Physician, State of California, Department of Health Services.

    Phone interview with Michael Ottlinger, Senior Toxicologist, Centers for Disease Control and Prevention, Cincinnati, OH.

    California Department of Health Services, Occupational Health Branch. "How to Prevent Lead Poisoning on Your Job." 2000. Pp. 5-8, 10, 38-40.

    National Center for Environmental Health. "Screening Young Children for Lead Poisoning." 1997. Available online at http://www.cdc.gov/nceh/lead/guide/97.htm.

    New York State Department of Health. "Lead Exposure in Adults—A Guide for Health Care Providers." Available online at http://www.health.state.ny.us/nysdoh/lead/hlthcare.htm.

    (2005 October 1). Lead Exposure in Children: Prevention, Detection, and Management. American Academy of Pediatrics, PEDIATRICS Vol. 116 No. 4 October 2005, Pp. 1036-1046.

    Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

    (2005 June 23, Reviewed) Lead Health Effects. U.S. Department of Labor, Occupational Safety & Health Administration [On-line information]. Available online at http://www.osha.gov/SLTC/lead/recognition.html.

    (2005 July, Updated). Lead Poisoning in Children. Familydoctor.org [On-line information]. Available online at http://familydoctor.org/617.xml.

    (2005 September, Revised). Management Guidelines for Blood Lead Levels in Children and Adults. California Department of Health Services [On-line information]. PDF available for download at http://www.dhs.ca.gov/ohb/OLPPP/mgmtgdln.pdf.

    Hipkins, K. et. al. (2004 November/December). Family Lead Poisoning Associated with Occupational Exposure. Clin Pediatr 2004;43:845-849. PDF available for download at http://www.dhs.ca.gov/ohb/OLPPP/family_lead_poisoning.pdf.

    (2005 May 25, Reviewed). CDC Childhood Lead Poisoning Prevention Program, CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children. CDC National Center for Environmental Health [On-line information]. Available online at http://www.cdc.gov/nceh/lead/Refugee%20recs.htm.

    (2005 September). ToxFAQs™ for Lead. Agency for Toxic Substances and Disease Registry (ATSDR) [On-line information]. Available online at http://www.atsdr.cdc.gov/tfacts13.html.

    (2005 September). Public Health Statement, from Toxicological Profile for Lead, Draft for Public Comment. Agency for Toxic Substances and Disease Registry (ATSDR) [[On-line information]. Available online at http://www.atsdr.cdc.gov/toxprofiles/tp13.html.

    (2006 January 13, Reviewed). General Lead Information, Questions and Answers. CDC, National Center for Environmental Health [On-line information]. Available online at http://www.cdc.gov/nceh/lead/faq/about.htm.

    (2002 March). Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. CDC [On-line information]. Available online at http://www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htm.

    (2003 September 12). Surveillance for Elevated Blood Lead Levels Among Children --- United States, 1997—2001. CDC MMWR [On-line information]. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5210a1.htm.

    (2004 July 9). Adult Blood Lead Epidemiology and Surveillance --- United States, 2002. CDC MMWR [On-line information]. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a2.htm.

    Harold E. Hoffman, MD, FRCPC, FACOEM. Occupational & Environmental Medicine. Edmonton, Alberta, Canada.

    Thomas P. Moyer, Ph.D. Professor of Laboratory Medicine, Mayo College of Medicine. Vice Chair for Diagnostic Development, Department of Laboratory Medicine & Pathology. Co-Director for Medical Affairs, Mayo Collaborative Services, Inc. Mayo Clinic, Rochester, MN.

    Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 474.

    Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 658-659.

    (Updated 2008 May 30). Lead. U.S. Dept of Labor OSHA [On-line information]. Available online at http://www.osha.gov/SLTC/lead/index.html. Accessed June 2009.

    (Updated 2009 February 01). Lead. ATSDR [On-line information]. Available online at http://www.atsdr.cdc.gov/substances/toxsubstance.asp?toxid=22. Accessed June 2009.

    (Updated 2007 October 05) ToxFAQs™ for Lead. ATSDR [On-line information]. Available online at http://www.atsdr.cdc.gov/tfacts13.html. Accessed June 2009.

    S6 (2009 May 19). Lead in Paint, Dust, and Soil. U.S. Environmental Protection Agency [On-line information]. Available online at http://www.epa.gov/opptintr/lead/index.html. Accessed June 2009.

    Alexander, D. (Updated 2007 May 25). Lead levels – blood [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003360.htm. Accessed June 2009.

    (2007 November 2). Interpreting and Managing Blood Lead Levels <10 µg/dL in Children and Reducing Childhood Exposures to Lead. CDC MMWR 56(RR08);1-14;16 [On-line information]. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5608a1.htm. Accessed June 2009.

    (Revised 2007 August 20). Case Studies in Environmental Medicine (CSEM), Lead Toxicity, What Tests Can Assist with Diagnosis of Lead Toxicity? ATSDR [On-line information]. Available online at http://www.atsdr.cdc.gov/csem/lead/pbtests_diagnosis2.html. Accessed June 2009.

    (Updated 2008 September) Lead Poisoning. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ToxinsTraceMetals/LeadPoisoning.html. Accessed June 2009.

    APHA. CDC Accepts Advisory Committee Recommendation to Replace "Level of Concern" for Lead Poisoning with New Reference Value. Washington, D.C. May 16, 2012. Available online at http://www.apha.org/about/news/pressreleases/2012/cdc+advisory+new+reference+value.htm. Accessed May 2012.

    Centers for Disease Control and Prevention. CDC Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in "Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention." PDF available for download at http://www.cdc.gov/nceh/lead/ACCLPP/CDC_Response_Lead_Exposure_Recs.pdf. Accessed May 2012.

    (January 4, 2012) Report of the Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention, Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention. PDF available for download at http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_011212.pdf. Accessed February 2012. 

    Centers for Disease Control and Prevention. Lead. Available online at http://www.cdc.gov/nceh/lead/. Accessed February 2012.

    CDC. Lead – Prevention Tips. Available online at http://www.cdc.gov/nceh/lead/tips.htm. Accessed February 2012.

    HealthyChildren.org. Lead Poisoning.  Available online through http://www.healthychildren.org. Accessed February 2012. 

    CDC. Lead – Case Management Document Chapter 3. Available online at http://www.cdc.gov/nceh/lead/CaseManagement/caseManage_chap3.htm. Accessed February 2012.

    American Academy of Pediatrics. Lead Exposure in Children: Prevention, Detection, and Management. Pediatrics Vol. 116 No. 4 October 1, 2005, Pp 1036 -1046. Available online at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/4/1036#SEC7. Accessed February 2012.

    OSHA. Lead. Available online at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10030. Accessed February 2012.

    OSHA Blood Lead Regulations. Available online at http://www.ehow.com/about_5538910_osha-blood-lead-regulations.html. Accessed April 2012.

    OSHA. Blood Lead Laboratories. Available onlne at http://www.osha.gov/SLTC/bloodlead/program.html. Accessed February 2012. 

    KidsHealth.org. Blood Test: Lead. Available online at http://kidshealth.org/parent/system/medical/test_lead.html#. Accessed February 2012. 

    Donald L. Simmons, Ph.D. Laboratory Manager. State Hygienic Laboratory - Ankeny Ankeny, IA.