A. Emergency and Supportive Measures
The most critical intervention in the treatment of lead poisoning is identification of and removal from the source of exposure. For patients with encephalopathy, maintain a patent airway and treat coma and convulsions as described at the beginning of this chapter.
For recent acute ingestion, if a large lead-containing object (eg, fishing weight) is still visible in the stomach on abdominal radiograph, whole bowel irrigation, endoscopy, or even surgical removal may be necessary to prevent subacute lead poisoning. (The acidic gastric contents may corrode the metal surface, enhancing lead absorption. Once the object passes into the small intestine, the risk of toxicity declines.)
The United States Occupational Safety and Health Administration (OSHA) establishes workplace standards for lead exposure. Contact the regional office for more information. Several states mandate reporting of cases of confirmed lead poisoning.
The indications for chelation depend on the blood lead level and the patient’s clinical state. A medical toxicologist or regional poison control center (1-800-222-1222) should be consulted for advice about selection and use of these antidotes.
Patients with severe intoxication (encephalopathy or levels greater than 70–100 mcg/dL) should receive edetate calcium disodium (ethylenediaminetetraacetic acid, EDTA), 1500 mg/m2/kg/day (approximately 50 mg/kg/day) in four to six divided doses or as a continuous intravenous infusion. Most clinicians also add dimercaprol (BAL), 4–5 mg/kg intramuscularly every 4 hours for 5 days, for patients with encephalopathy.
Patients with less severe symptoms and asymptomatic patients with blood lead levels between 55 and 69 mcg/dL may be treated with edetate calcium disodium alone in dosages as above. An oral chelator, succimer (DMSA), is available for use in patients with mild to moderate intoxication. The usual dose is 10 mg/kg orally every 8 hours for 5 days, then every 12 hours for 2 weeks.
et al. Lead in spices, herbal remedies, and ceremonial powders sampled from home investigations for children with elevated blood lead levels—North Carolina, 2011–2018. MMWR Morb Mortal Wkly Rep. 2018 Nov 23;67(46):1290–4.
et al. Lead exposure at firing ranges—a review. Environ Health. 2017 Apr 4;16(1):34.
. Lead poisoning in children and adults. Dimens Crit Care Nurs. 2017 Jan/Feb;36(1):71–3.
A. Childhood lead exposure and adult neurodegenerative disease. J Alzheimers Dis. 2018;64(1):17–42.