Management of elevated blood lead level 3.5 mcg/dL to 49 mcg/dL in non-pregnant adults

BLL: blood lead level; BUN: blood urea nitrogen; CBC: complete blood count; CNS: central nervous system; FEP: free erythrocyte protoporphyrin.

* Blood lead levels reflect both ongoing sources of lead exposure that may be occurring as well as the constant outflow of lead from any internal stores that have accumulated over time. The primary internal storage site is bone, where lead stores have a residence time ranging from years to decades. Sources of ongoing lead exposure include workplace (eg, plumbers, smelters, miners, painters, construction workers), hobbies (eg, target shooting at firing ranges), retained bullets, and others (eg, folk remedies). Refer to UpToDate content and table on sources of lead exposure for expanded list and discussion on obtaining an exposure history.

¶ Maternal lead exposure may increase the risk of spontaneous abortion, preterm birth, small for gestational age, and increased blood pressure (pre-eclampsia). Refer to UpToDate content on occupational and environmental risks to reproduction in females.

Δ If source of exposure has been identified and control measures have been instituted, when elevated BLL is reduced to <15 mcg/dL, BLL may be monitored every three months. Refer to UpToDate content for further recommendations on BLL monitoring.

◊ Health-related effects are dose-dependent and vary based on duration of exposure.

• Short term exposure, mild to moderate increase in BLL: difficulty concentrating, headache, fatigue, myalgias, irritability
• Higher BLLs, particularly with prolonged exposure: abdominal pain, constipation, ileus, arthralgias, weakness, motor neuropathy (extensor weakness), anemia, semen abnormalities, memory impairment, lead line
• Extremely high BLLs: delirium, seizures
• Long-term exposure, even with mild increase in BLL: increased blood pressure, cardiovascular problems, tremor, decreased kidney function, increased cognitive aging

Refer to UpToDate content and table on effects associated with lead exposure in adults.