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Adult occupational lead poisoning

Authors
Rose H Goldman, MD, MPH
Howard Hu, ScD, MD
Section Editors
Joann G Elmore, MD, MPH
Stephen J Traub, MD
Deputy Editor
Lee Park, MD, MPH

INTRODUCTION

Lead poisoning can present with nonspecific signs and symptoms such as abdominal pain, constipation, irritability, difficulty concentrating, and anemia. 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 dramatically reduced if not entirely prevented by eliminating and decreasing sources of exposures and by early recognition of elevated lead levels or lead poisoning.

This topic will focus on occupational lead poisoning, primarily in the United States  . Some of the clinical conditions related to lead poisoning and issues related to lead poisoning in children are presented separately. (See "Sideroblastic anemias: Diagnosis and management" and "Lead nephropathy and lead-related nephrotoxicity" and "Childhood lead poisoning: Clinical manifestations and diagnosis" and "Childhood lead poisoning: Management".)

DIMENSIONS OF THE PROBLEM

The true extent of adult lead poisoning in the United States is difficult to measure because of limited data and changing definitions of elevated blood lead levels (BLL).

Definition — The Centers for Disease Control and Prevention (CDC)'s Adult Blood Lead Epidemiology and Surveillance (ABLES) program monitors laboratory-reported elevated BLL among adults in 41 states [1]. In 2009, ABLES changed the definition of elevated BLL from ≥25 mcg/dL (1.21 micromol/L) to >10 mcg/dL (0.48 micromol/L) based on research demonstrating adverse health effects at lower levels [1,2]. In 2015, ABLES changed the definition of elevated BLL to >5 mcg/dL [1]. The US Department of Health and Human Services recommends that lead levels for adults be kept below 10 mcg/dL [1]. (See 'Approach to management' below.)

                           

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Literature review current through: Aug 2016. | This topic last updated: Sep 8, 2016.
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