Lead poisoning

Lead used to be very common in gasoline and house paint in the United States. In children, lead exposure often occurs through ingestion. Children living in cities with older houses are more likely to have high levels of lead in their blood or body. In the United States, it is estimated that half a million children ages 1 through 5 years have unhealthy levels of lead in their bloodstream. In adults, lead exposure is usually through inhalation in the work environment.

Immigrant and refugee children are at much greater risk for lead poisoning than children born in the United States because of diet and other exposure risks before arriving in the United States.

Although gasoline and paint are no longer made with lead in them, lead is still a health problem. Lead is everywhere, including dirt, dust, new toys, and old house paint. Unfortunately, you cannot see, taste, or smell lead.

In 2014, health organizations estimated that nearly a quarter billion people worldwide had toxic (poisonous) blood lead levels.

Lead is found in:

• Houses painted before 1978. Even if the paint is not peeling, it can be a problem. Lead paint is very dangerous when it is being stripped or sanded. These actions release fine lead dust into the air. Infants and children living in pre-1960's housing (when paint often contained lead) have the highest risk of lead poisoning. Small children often swallow paint chips or dust from lead-based paint.
• Toys and furniture painted before 1976.
• Painted toys and decorations made outside the United States
• Lead bullets, fishing sinkers, curtain weights.
• Plumbing, pipes, and faucets. Lead can be found in drinking water in homes containing pipes that were connected with lead solder. Although new building codes require lead-free solder, lead is still found in some modern faucets.
• Soil contaminated by decades of car exhaust or years of house paint scrapings. Lead is more common in soil near highways and houses.
• Hobbies involving soldering, stained glass, jewelry making, pottery glazing, and miniature lead figures (always look at labels).
• Children's paint sets and art supplies (always look at labels).
• Pewter, some glass, ceramic or glazed clay pitchers and dinnerware.
• Lead-acid batteries, such as ones used in car engines.

Children get lead in their bodies when they put lead objects in their mouths, especially if they swallow those objects. They can also get lead on their fingers from touching a dusty or peeling lead object, and then putting their fingers in their mouths or eating food afterward. Children also can breathe in tiny amounts of lead.

There are many possible symptoms of lead poisoning. Lead can affect many different parts of the body. A single high dose of lead can cause severe emergency symptoms.

However, it is more common for lead poisoning to occur slowly over time. This results from repeated exposure to small amounts of lead. In this case, there may not be any obvious symptoms. Over time, even low levels of lead exposure can harm a child's mental development. The health problems get worse as the level of lead in the blood gets higher.

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

Possible complications include:

• Behavior or attention problems
• Failure at school
• Hearing problems
• Kidney damage
• Reduced IQ
• Slowed body growth

The symptoms of lead poisoning may include:

• Abdominal pain and cramping (usually the first sign of a high, toxic dose of lead)
• Aggressive behavior
• Anemia (low red blood cell count)
• Constipation
• Difficulty getting pregnant
• Difficulty sleeping
• Headaches
• Hearing loss
• Irritability
• Loss of previous developmental skills (in young children)
• Low appetite and energy
• Reduced sensations

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

You can reduce exposure to lead with the following steps:

• If you suspect you may have lead paint in your house, get advice on safe removal from the National Lead Information Center -- www.epa.gov/lead at (800) 424-5323.
• Keep your home as dust-free as possible.
• Have everyone wash their hands before eating.
• Throw out old painted toys if you do not know whether the paint contains lead.
• Let tap water run for a minute before drinking or cooking with it.
• If your water has tested high in lead, consider installing an effective filtering device or switch to bottled water for drinking and cooking.
• Avoid canned goods from foreign countries until the ban on lead soldered cans goes into effect.
• If imported wine containers have a lead foil wrapper, wipe the rim and neck of the bottle with a towel moistened with lemon juice, vinegar, or wine before using.
• DO NOT store wine, spirits, or vinegar-based salad dressings in lead crystal decanters for long periods of time, because lead can get into the liquid.

Provide the following information to emergency assistance:

• The person's age, weight, and condition
• The name of the product or the object you think had lead in it
• The date/time the lead was swallowed or inhaled
• The amount swallowed or inhaled

However, DO NOT delay calling for help if this information is not immediately available.

If someone has severe symptoms from possible lead exposure (such as vomiting or seizures) call 911 immediately.

For other symptoms that you think may be caused by lead poisoning, call your local poison control center.

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Except in severe cases where someone has been exposed to a high dose of lead, a trip to the emergency room is not necessary. Contact your health care provider or department of public health if you suspect possible low-level lead exposure.

A blood lead test can help identify whether a problem exists. Over 10 mcg/dL (0.48 µmol/L) is a definite concern. Levels from 2 to 10 mcg/dL (0.10 and 0.48 µmol/L) should be discussed with your health care provider. In many states, blood screening is recommended for young children at risk.

Other lab tests may include:

• Bone marrow biopsy (sample of bone marrow)
• Complete blood count (CBC) and coagulation (ability of blood to clot) studies
• Free erythrocyte protoporphyrin (type of protein in red blood cells) levels
• Lead level
• X-ray of the long bones and abdomen

For children whose blood levels of lead are moderately high, identify all major sources of lead exposure and keep the child away from them. Follow-up blood testing may be needed.

Chelation therapy (compounds that bind lead) is a procedure that can remove high levels of lead that have built up in a person's body over time.

In cases where someone has potentially eaten a high toxic dose of lead in a short period of time, the following treatments might be done:

• Bowel irrigation (flushing out) with polyethylene glycol solution
• Gastric lavage (washing out the stomach)

Adults who have had mildly high lead levels often recover without problems. In children, even mild lead poisoning can have a permanent impact on attention and IQ.

People with higher lead levels have a greater risk of long-lasting health problems. They must be followed carefully.

Their nerves and muscles can be greatly affected and may no longer function as well as they should. Other body systems may be harmed to various degrees, such as the kidneys and blood vessels. People who survive toxic lead levels may have some permanent brain damage. Children are more vulnerable to serious long-term problems.

A complete recovery from chronic lead poisoning may take months to years.

Plumbism

Centers for Disease Control and Prevention website. Childhood lead poisoning prevention. www.cdc.gov/lead-prevention/about/. Updated May 23, 2024. Accessed June 19, 2024.

Markowitz M. Lead poisoning. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 739.

Theobald JL, Mycyk MB. Iron and heavy metals. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 146.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 04/17/2023.