Lead Poisoning

What is pediatric lead poisoning?

A toxic exposure resulting in accumulation of lead, causing neurologic, hematologic, and developmental dysfunction.

What is the most common source of lead exposure in children?

Lead-based paint in homes built before 1978.

How do children most commonly ingest lead?

Hand-to-mouth activity involving contaminated dust, paint chips, soil, or household items.

What populations are at highest risk for lead poisoning?

• Children <6 years

• Living in older housing

• Low socioeconomic status

• Immigrant/refugee families

What are common sources of lead exposure?

• Lead paint

• Contaminated dust

• Soil

• Imported toys

• Pottery

• Cosmetics

• Water from lead pipes

How does lead cause neurologic toxicity?

Lead disrupts neurotransmitter release and damages developing CNS pathways, especially in young children.

How does lead cause anemia?

Lead inhibits heme synthesis, causing microcytic anemia.

What are symptoms of mild lead poisoning?

• Irritability

• Fatigue

• Headache

• Abdominal pain

• Constipation

What are symptoms of moderate to severe lead poisoning?

• Cognitive impairment

• Developmental delay

• Behavioral problems

• Ataxia

• Seizures

What GI symptoms are associated with lead poisoning?

• Abdominal pain

• Constipation

• Vomiting

What neurologic findings may occur in severe lead poisoning?

• Ataxia

• Seizures

• Encephalopathy

What CBC finding is associated with lead poisoning?

Microcytic anemia.

What peripheral smear finding is associated with lead poisoning?

Basophilic stippling.

What lab test is used to diagnose lead poisoning?

Venous blood lead level (BLL).

What blood lead level is considered elevated?

*≥5 µg/dL.

What blood lead level requires urgent chelation therapy?

≥45 µg/dL.

What blood lead level is associated with severe toxicity and encephalopathy?

≥70 µg/dL.

What imaging finding may be seen in chronic lead ingestion?

Lead lines on metaphyses of long bones.

What is the first-line chelation therapy for BLL ≥45 µg/dL?

Succimer (DMSA).

What chelation therapy is used for severe lead poisoning with encephalopathy?

EDTA (calcium disodium EDTA).

What environmental interventions are essential in lead poisoning?

• Remove lead sources

• Wet-clean surfaces

• Repair peeling paint

• Avoid contaminated soil

What nutritional deficiencies worsen lead absorption?

• Iron deficiency

• Calcium deficiency

Why does iron deficiency worsen lead toxicity?

Lead competes with iron for absorption and incorporation into heme.

What dietary measures help reduce lead absorption?

• Adequate iron intake

• Adequate calcium intake

• Regular meals (reduces GI absorption)

What developmental complications can result from chronic lead exposure?

• Cognitive impairment

• Learning disabilities

• Behavioral problems

• ADHD-like symptoms

What is the most serious complication of acute severe lead poisoning?

Encephalopathy.

What symptoms suggest lead encephalopathy?

• Vomiting

• Ataxia

• Seizures

• Altered mental status

What follow-up is required after elevated lead levels?

Repeat venous BLL testing at intervals based on severity.

What public health agencies should be notified for elevated lead levels?

Local/state health departments.

What household measures reduce lead exposure risk?

• Wet-mopping floors

• Frequent handwashing

• Cleaning toys

• Avoiding renovation dust

What conditions can mimic lead poisoning?

• Iron deficiency anemia

• ADHD

• Autism spectrum disorders

• Hypothyroidism

What feature helps differentiate lead poisoning from iron deficiency anemia?

*Basophilic stippling and elevated lead level.

What feature helps differentiate lead poisoning from ADHD?

ADHD lacks anemia, GI pain, or neurologic signs.

What feature helps differentiate lead poisoning from autism?

Autism does not cause anemia or abdominal pain.