Lead poisoning can present with nonspecific signs and symptoms such as abdominal pain, constipation, irritability, difficulty concentrating, and anemia. Clinicians need to consider this diagnosis and know the appropriate tests to order for documenting exposure and assessing for early health effects. It is also now well-established that chronic exposure to modest levels of lead, too low to trigger symptoms, can increase risk for hypertension and accelerated future cognitive and renal decline in adults.
Clinicians need to know how to play a proactive role in early detection and prevention by screening patients known to work in occupations with possible lead exposure, and what actions to take when excessive exposure is found. The costs and consequences of lead poisoning can be entirely prevented by eliminating and decreasing sources of exposures and by early recognition of elevated lead levels or lead poisoning.
Some of the clinical conditions related to lead poisoning and issues related to lead poisoning in children are presented separately. (See "Clinical aspects, diagnosis, and treatment of the sideroblastic anemias" and "Lead nephropathy and lead-related nephrotoxicity".)
DIMENSIONS OF THE PROBLEM
The true extent of adult lead poisoning in the United States (US) is difficult to measure because of limited data. One source of data is the Centers for Disease Control's (CDC's) Adult Blood Lead Epidemiology and Surveillance (ABLES) program that monitors laboratory reported elevated blood lead levels (BLLs) among adults in 41 states . An elevated BLL had previously been defined as greater than or equal to 25 mcg/dL (1.21 micromol/L), but in 2009 ABLES updated its definition to >10mcg/dL (0.48 micromol/L) . This is consistent with the decrease in BLLs in the US population and newer research demonstrating adverse health effects at lower levels . (See 'Management' below.)
The ABLES surveillance results have indicated an overall decrease in the US prevalence of elevated BLLs from 14.0 per 100,000 in 1994 to 6.3 in 2009 . Ninety-four percent of the adults with an identified exposure source were exposed at work. These work exposures occurred mainly in battery manufacturing, lead and zinc ore mining, and painting and paper hanging industry subsectors. Despite these improvements, there are still thousands of adults in the US with high BLLs (>40 mcg/dL [1.93 micromol/L]) .