How is lead toxicity treated in adults?

Updated: Jan 16, 2020
  • Author: Pranay Kathuria, MD, FACP, FASN, FNKF; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

The recommendations for management of adults are summarized below: [31]

BLL < 5 µg/dl: No action needed.

BLL 5–9 µg/dl: Discuss health risks and reduce exposure during pregnancy

BLL 10–19 µg/dl: Discuss health risks, decrease exposure, monitor BLL and remove from exposure for pregnancy, certain medical conditions, and long term risks.

BLL 20–29 µg/dl: Remove from exposure during pregnancy, remove from exposure if repeat BLL in 4 weeks remains > 20 µg/dl and an annual lead medical exam is recommended.

BLL 30–49 µg/dl: Remove from exposure and provide prompt medical evaluation

BLL 50–79 µg/dl: Remove from exposure. Provide prompt medical evaluation and consider chelation with significant symptoms

BLL> 80 µg/dl: Remove from exposure and provide urgent medical evaluation. Chelation may be indicated. [31]

The US Occupational Safety and Health Administration (OSHA) has recommendations for occupational lead exposure. Under these guidelines, the permissible exposure limit is 50 µg/m3 for an 8-hour, time-weighted average. Workers with blood lead levels (BLLs) of 60 µg/dL or higher must be removed from the workplace. Additionally, employees should be removed from the workplace if the average of their last 3 BLLs is 50 µg/dL or higher. Individuals with BLLs of 40 µg/dL or higher must undergo medical evaluation. [32]

Medical treatment (ie, chelation therapy) is but one element of a comprehensive treatment plan for exposure to lead; removal of the source of lead exposure is more important. The interventions described below relate to chelation therapy for the most severe cases of lead poisoning. Chelation is of only transient benefit in the patient whose source of lead exposure has not been identified and removed.


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