Alternate Names: Plumbism

Causes and Risks: Lead occurs naturally in the environment at very low levels. Relatively high level sources of lead occur in older paint (modern paint does not contain lead), and pre-1980 car exhaust (the lead from exhaust is ultimately deposited on the ground in dust which children play in). Other sources exist such as pewter pitchers and dinnerware, birdshot and fishing weights. In the past, toothpaste tubes were made of lead and condensed milk cans were soldered with lead. This has been corrected. Lead can also be found in drinking water from homes whose copper pipes were soldered with lead solder. New building codes require lead free solder.

Infants and children most at risk are those living in pre-sixties housing where paint often contained led. These children, when small, often ingest paint chips or dust from lead based paint. Soil in cities with high traffic density may contain high levels of lead from car exhaust.

There are few clear cut symptoms of lead poisoning. Very high levels may lead to an acute encephalopathy. Low levels of lead are thought to be detrimental to mental development and have been implicated in decreased IQ and mental functioning. Hard evidence for this, however, is still questionable. Anemia with lead poisoning is common.

Specific symptoms are nebulous but hyperirritability, decreased appetite and energy, and loss of recently acquired developmental skills. Abdominal cramping may be present.

In severe intoxication lead encephalopathy develops with vomiting, staggering gait, motor weakness from peripheral neuropathy, seizures and coma.

Prevention: Avoidance of lead ingestion or inhalation

Symptoms: Acute

• vomiting
• headache
• staggering gait
• seizures
• coma

• HISTORY OF EXPOSURE to lead containing paint, dirt, etc.
• irritability
• loss of appetite
• loss of energy
• colic or abdominal cramping
• loss or recently acquired developmental skills
• decreased intellectual functioning

Signs and Tests:

• anemia
• behavioral disorders
• school problems
• encephalopathy
• increased intracranial pressure

• serum lead levels
• erythrocyte protoporphyrin
• bone marrow biopsy (stippled erythroblasts)
• X-ray of the long bones

Treatment:

• removal from the source of lead (often easier than removing the source of lead)
• chelation therapy to remove lead from the body

Prognosis: Expectations vary depending on the severity of toxicity. Children with levels above normal (greater than 30 micrograms/cc but less than 50) generally recover without problem. Children with medium and high serum levels of lead must be carefully followed and removed from all exposure. Children who have had an acute encephalopathy have a more guarded prognosis. Even mild lead poisoning is suspected as causing poor school performance and some loss in IQ.

Complications: acute encephalopathy

Call for an appointment with your health care provider if signs of lead poisoning exist.