Recommendations for medical management of adult lead exposure.
Research conducted in recent years has increased public health concern about the toxicity of lead at low dose and has supported a reappraisal of the levels of lead exposure that may be safely tolerated in the workplace. In this article, which appears as part of a mini-monograph on adult lead exposure, we summarize a body of published literature that establishes the potential for hypertension, effects on renal function, cognitive dysfunction, and adverse female reproductive outcome in adults with whole-blood lead concentrations < 40 microg/dL. Based on this literature, and our collective experience in evaluating lead-exposed adults, we recommend that individuals be removed from occupational lead exposure if a single blood lead concentration exceeds 30 microg/dL or if two successive blood lead concentrations measured over a 4-week interval are > or = 20 microg/dL. Removal of individuals from lead exposure should be considered to avoid long-term risk to health if exposure control measures over an extended period do not decrease blood lead concentrations to < 10 microg/dL or if selected medical conditions exist that would increase the risk of continued exposure. Recommended medical surveillance for all lead-exposed workers should include quarterly blood lead measurements for individuals with blood lead concentrations between 10 and 19 microg/dL, and semiannual blood lead measurements when sustained blood lead concentrations are < 10 microg/dL. It is advisable for pregnant women to avoid occupational or avocational lead exposure that would result in blood lead concentrations > 5 microg/dL. Chelation may have an adjunctive role in the medical management of highly exposed adults with symptomatic lead intoxication but is not recommended for asymptomatic individuals with low blood lead concentrations.
Kosnett
Michael J
MJ
Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80202, USA. Michael.Kosnett@uchsc.edu
Wedeen
Richard P
RP
Rothenberg
Stephen J
SJ
Hipkins
Karen L
KL
Materna
Barbara L
BL
Schwartz
Brian S
BS
Hu
Howard
H
Woolf
Alan
A
D000328:Adult; D000818:Animals; D015913:Chelation Therapy; D004781:Environmental Exposure / Q000009:adverse effects* / Q000517:prevention & control; D004785:Environmental Pollutants / Q000097:blood / Q000633:toxicity*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007753:Laboratories; D007774:Lactation; D007854:Lead / Q000097:blood / Q000633:toxicity*; D007855:Lead Poisoning / Q000188:drug therapy; D011247:Pregnancy
D004785:Environmental Pollutants; D007854:Lead