lead poisoning (plumbism)

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Etiology

Epidemiology

  • CDC set safe limit for blood lead level as < 10 ug/dL
  • previously < 25 ug/dL was considered acceptable
  • nearly 3% of U.S. children age 1-5 years have elevated blood lead levels[7]
  • lead poisoning confirmed in children of Flint Michigan after their water source was switched from the Detroit Water Authority (DWA), sourced from Lake Huron, to the Flint Water System (FWS), sourced from the Flint River[10]
  • 400,000 deaths/year in U.S. related to lead exposure[12]*

* higher baseline blood lead levels associated with higher risk of cardiovascular mortality (RR=1.29) & all-cause mortality (RR-1.18), 90th percentile (6.7 ug/dL) vs 10th percentile (1.0 ug/dL)[12]

* RR=1.27 for mortality due to ischemic heart disease[12]

Pathology

Clinical manifestations

Laboratory

Radiology

Complications

Differential diagnosis

Management

More general terms

Additional terms

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1167-68
  2. 2.0 2.1 2.2 2.3 Stewart WF et al, Past adult lead exposure is linked to neurodegeneration measured by brain MRI. Neurology 2006, 66:1476 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16717205
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 18. American College of Physicians, Philadelphia 2006, 2012, 2018.
  4. U.S. Preventive Services Task Force Screening for Lead Levels in Childhood and Pregnancy http://www.ahrq.gov/clinic/uspstf/uspslead.htm
  5. 5.0 5.1 5.2 Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention Report of the Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_010412.pdf
    Centers for Disease Control and Prevention Advisory Committee On Childhood Lead Poisoning Prevention (ACCLPP) http://www.cdc.gov/nceh/lead/ACCLPP/acclpp_main.htm
  6. 6.0 6.1 Centers for Disease Control and Prevention Infant Lead Poisoning Associated with Use of Tiro, an Eye Cosmetic from Nigeria - Boston, Massachusetts, 2011 MMWR. August 3, 2012 / 61(30);574-576 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6130a3.htm
  7. 7.0 7.1 Centers for Disease Control and Prevention Blood Lead Levels in Children Aged 1-5 Years - United States, 1999-2010 MMWR. April 5, 2013 / 62(13);245-248 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6213a3.htm
  8. Ekong EB, Jaar BG, Weaver VM. Lead-related nephrotoxicity: a review of the epidemiologic evidence. Kidney Int. 2006 Dec;70(12):2074-84 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17063179
  9. 9.0 9.1 Newman N, Jones C, Page E et al Investigation of Childhood Lead Poisoning from Parental Take- Home Exposure from an Electronic Scrap Recycling Facility - Ohio, 2012. MMWR Weekly. July 17, 2015 / 64(27);743-745 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6427a3.htm
  10. 10.0 10.1 10.2 Kennedy C, Yard E, Dignam T, et al. Blood Lead Levels Among Children Aged < 6 Years - Flint, Michigan, 2013-2016. MMWR Morb Mortal Wkly Rep. ePub: 24 June 2016 http://www.cdc.gov/mmwr/volumes/65/wr/mm6525e1.htm
  11. 11.0 11.1 Reuben A, Caspi A, Belsky DW et al Association of Childhood Blood Lead Levels With Cognitive Function and Socioeconomic Status at Age 38 Years and With IQ Change and Socioeconomic Mobility Between Childhood and Adulthood. JAMA. 2017;317(12):1244-1251 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28350927 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2613157
    Bellinger DC Childhood Lead Exposure and Adult Outcomes. JAMA. 2017;317(12):1219-1220 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28350907 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2613136
  12. 12.0 12.1 12.2 12.3 12.4 Lanphear BP, Rauch S, Auinger P, et al Low-level lead exposure and mortality in US adults: a population-based cohort study. Lancet Public Health. March 12, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29544878 Free full text <Internet> http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30025-2/fulltext
  13. 13.0 13.1 US Preventive Services Task Force Screening for Elevated Blood Lead Levels in Children and Pregnant Women. US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321(15):1502-1509. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30990556 https://jamanetwork.com/journals/jama/fullarticle/2730621
    Cantor AG, Hendrickson R, Blazina I et al Screening for Elevated Blood Lead Levels in Childhood and Pregnancy. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2019;321(15):1510-1526. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30990555 https://jamanetwork.com/journals/jama/fullarticle/2730620
    Spanier AJ, McLaine P, Gilden RC. Screening for Elevated Blood Lead Levels in Children and Pregnant Women. JAMA. 2019;321(15):1464-1465. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30990534 https://jamanetwork.com/journals/jama/fullarticle/2730594
  14. 14.0 14.1 Helmich F, Lock G. Burton's Line from Chronic Lead Intoxication. N Engl J Med 2018; 379:e35. Nove 8, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30403939 https://www.nejm.org/doi/full/10.1056/NEJMicm1801693
  15. Zamani N, Hassanian-Moghaddam H Ingestion of Lead-Contaminated Packs of Opium. N Engl J Med 2018; 379:1861. Nov 8, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30403949 https://www.nejm.org/doi/full/10.1056/NEJMicm1807901
  16. Lin JL, Lin-Tan DT, Li YJ, Chen KH, Huang YL. Low-level environmental exposure to lead and progressive chronic kidney diseases. Am J Med. 2006 Aug;119(8):707.e1-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16887418
  17. ARUP Consult: Trace Elements - Deficiency and Toxicity The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/trace-minerals
  18. 18.0 18.1 Rothaus C Lead Astray NEJM Resident 360. Aug 5, 2020 https://resident360.nejm.org/clinical-pearls/led-astray
  19. National Institute of Environmental Health Sciences Lead https://kids.niehs.nih.gov/topics/chemicals/lead/index.htm

Patient information

lead poisoning patient information