Management overview for lead poisoning

Most cases of lead poisoning are due to chronic ingestion of lead from contaminated substances, resulting in lead accumulation in the body over a period of time. Lead accumulates in bone with prolonged exposure and is released into the blood long after the source of exposure is removed. Children and unborn babies are particularly susceptible to lead toxicity, as prolonged exposure to low concentrations of lead can significantly affect the developing central nervous system (CNS). Iron and calcium deficiencies can increase lead absorption.

Acute lead poisoning is rare, but potentially life threatening and may follow ingestion or inhalation of lead. For management of ingestion of a lead object, see Lead object ingestion.

Common sources of lead in Australia are listed in Common sources of lead in Australia. In Australia, most lead exposure results from environmental contamination, especially in and around housing in mining towns and near smelters (notably Port Pirie, South Australia; Mt Isa, Queensland; Broken Hill, New South Wales). There are also occupational exposure risks to those working in mining and manufacturing industries (eg manufacture of batteries, pigments, solder, ammunition and car radiators).

Table 1. Common sources of lead in Australia
[NB1]
Sources of lead	Route of exposure
lead dust lead-contaminated soil lead paint and lead paint chips lead-contaminated food food cooked in or eaten from lead-glazed ceramic ware or lead pots and pans water from lead-lined piping illegally distilled alcohol imported Ayurvedic and traditional Chinese medicines lead pellets lead sinkers lead curtain weights lead-contaminated illicit drugs, such as opium	ingestion or inhalation
lead shot from guns embedded in tissues or joints lead-contaminated cosmetics	physical contact with lead-contaminated objects
Note: NB1: For a more comprehensive list of sources of lead exposure, see the 2016 National Health and Medical Research Council report on managing individual exposure to lead in Australia.

The main clinical concerns from lead exposure are neurological (encephalopathy, seizures, cognitive and developmental impairment). Refer patients with suspected lead poisoning to hospital for assessment and treatment if they have an altered conscious state or seizures.

Refer any patient with any a detectable whole blood lead concentration, even if asymptomatic, to a clinician with experience in managing lead poisoning, a clinical toxicologist, or poisons information centre (13 11 26) for evaluation; this is particularly important for children and pregnant people. If there is a detectable whole blood lead concentration that warrants chelation therapy, refer the patient to hospital. Chelation therapy can be administered in an outpatient setting for clinically stable patients.

There is no established safe level of lead exposure and all exposures should be avoided. Identification of the lead source and removal of the patient from that source of exposure are the most important medical interventions. Pregnant people and children need to be immediately removed from the source of lead exposure, and monitored.

Note: Identification of, and removal of the patient from, the lead source are the most important interventions at any level of lead exposure.

The National Health and Medical Research Council report into lead poisoning in Australia is a useful resource for the management of lead poisoning¹.

¹ National Health and Medical Research Council (NHMRC). Managing individual exposure to lead in Australia - A guide for health professionals. Canberra: NHMRC; 2016. [URL]Return