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For further information, see CMDT Part 38-39: Lead Poisoning

Key Features

  • Results from chronic repeated exposure; rare after single ingestion

  • Produces a variety of adverse effects on cellular function; primarily affects the nervous system, gastrointestinal tract, and hematopoietic system

  • Lead is used in firearms ammunition, storage batteries, paints, pottery, plumbing and is found is some traditional Hispanic and Ayurvedic ethnic medicines

Clinical Findings

  • Abdominal pain, constipation, headache, irritability

  • Coma and convulsions in severe poisoning

  • Chronic intoxication can cause learning disorders (in children) and motor neuropathy (eg, wristdrop)


  • Whole blood lead levels above 5 mcg/dL warrant public health investigation

  • Blood lead levels

    • Levels between 10 and 25 mcg/dL have been associated with impaired neurobehavioral development in children

    • Levels of 25–50 mcg/dL may be associated with headache, irritability, and subclinical neuropathy

    • Levels of 50–70 mcg/dL are associated with moderate toxicity (eg, abdominal pain, constipation)

    • Levels > 70–100 mcg/dL are often associated with severe poisoning (eg, coma, convulsions)

  • Microcytic anemia with basophilic stippling and elevated free erythrocyte protoporphyrin may be seen


  • Identify and remove the source of exposure

  • If a lead object is visible on abdominal radiograph, whole-bowel irrigation, endoscopy, or surgical removal may be necessary

  • Consult a medical toxicologist or regional poison control center for advice about chelation

  • For severe intoxication (encephalopathy or levels > 70–100 mcg/dL), give edetate calcium disodium (EDTA), 1500 mg/m2/kg/day (~50 mg/kg/day) in four to six divided doses or as a continuous intravenous infusion

  • Dimercaprol, 4–5 mg/kg every 4 hours intramuscularly for 5 days, is usually added if the patient is encephalopathic

  • Less severe symptoms with blood lead levels between 55 and 69 mcg/dL may be treated with EDTA alone in dosages as above

  • Succimer (dimercaptosuccinic acid), 10 mg/kg every 8 hours orally for 5 days, then every 12 hours for 2 weeks for mild to moderate cases

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