Recognizing adult lead poisoning for health care professionals

Medical Management of Lead Poisoning in Adults

Blood Lead Level
(g/dL)*

Management Recommendations

<5

- No action required

5-9 10-19
20-29 30-79 80

- Lead education - Discuss possible exposures - Monitor BLL - Decrease exposure - Eliminate exposure source
for pregnancy - Consider exposure
elimination for certain medical conditions
- Repeat BLL in 4 weeks and remove from exposure if BLL remains 20
- Perform annual lead medical exam
- Eliminate exposure source for all persons
- Prompt medical evaluation - Urgent medical evaluation - Chelation therapy may be
indicated

* According to the Occupational Safety and Health Administration (OSHA), the permissible blood lead level for workers in general industry is below 60g/dL and below 50g/dL for workers in the construction industry. At these levels, OSHA requires workers to be medically removed from the source of lead exposure. However, OSHA job protections also apply when a licensed health care provider removes an individual from lead exposure, regardless of the blood lead level, due to a lead related problem or medical condition.

For More Information:
OSHA Medical Surveillance Guidelines
osha.gov/pls/oshaweb/owadisp.show_document?p_table=S TANDARDS&p_id=10033
Georgia Healthy Homes and Lead Poisoning Prevention Program
dph.georgia.gov/healthy-homes-and-lead-poisoningprevention
Georgia Occupational Health Surveillance Program
dph.georgia.gov/georgia-occupational-health-and-safetysurveillance-program
For Consultation:
Georgia Poison Center
Call: 1-800-222-1222
georgiapoisoncenter.org
Resources:
Medical Management of Adult Lead Exposure
Kosnett MJ, Wedeen RP, Rothenberg SJ, et al. Recommendations for Medical Management of Adult Lead Exposure. Environmental Health Perspectives. 2007;115(3):463-471. doi:10.1289/ehp.9784.
Lead Toxicity Who Is at Risk of Lead Exposure?
https://www.atsdr.cdc.gov/csem/csem.asp?csem=34&po=7
CSTE: Management Guidelines for Blood Lead Levels in Adults
http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/Occ upationalHealth/ManagementGuidelinesforAdult.pdf
Adult Blood Lead Epidemiology and Surveillance (ABLES) Publications
cdc.gov/niosh/topics/ables/publication.html

Recognizing Adult Lead Poisoning for Health Care Professionals
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Lead Poisoning Symptoms
The Centers for Disease Control and Prevention (CDC) states that a blood lead level (BLL) of 5 g/dL or greater can result in lead poisoning. The signs and symptoms generally become more noticeable as BLLs increase and with chronic lead exposure.

Asking about Patients' Occupation
About 90% of adult lead poisonings are caused by occupational exposures.
Ask your patients if they or someone they live with works in any of these workplaces
or occupations:
Air conditioning Auto repair industry Battery manufacturing Construction Firing range and gunsmithing Glass manufacturing Law enforcement Lead manufacturing Painting Plastic manufacturing Plumbing and pipe-fitting Recycling of metal, electronics, and
batteries Rubber manufacturing Shipbuilding Solid waste incinerating Welding

Inquiring about Patients' Living Specifics
The following questions may aid you in identifying sources of exposure:
Does the patient live in a home constructed before 1978? (The paint and plumbing may contain lead)
Does the patient live in an inner-city with older rental homes?
Does the patient live near a lead source, such as a battery recycling center?
Does the patient live with someone with an identified elevated BLL or who works in a lead-related industry?
Does the patient cook or store food in traditional ceramic pottery imported from Latin America or Asian countries?
Does the patient use cosmetics imported from India, the Middle East or West Asia, such as Kohl or Surma?

Source: https://en.wikipedia.org/wiki/Lead_poisoning#/med ia/File:Symptoms_of_lead_poisoning_(raster).png

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