The last few months have seen a lot of media coverage over the threat of lead poisoning.  With the Christmas giving season upon us, Registered Nurses will see an increase in questions about lead poisoning: its sources, its signs and symptoms, as well as its treatment.  This is a crash course to prepare you these types of questions as well as the parameters of nursing and medical care when you encounter a case of lead poisoning.

Lead Poisoning is also referred to as plumbism which is Latin for “lead condition”.  It is simply a condition of having elements of lead within the blood.

Lead is a naturally occurring environmental element found in the earth’s crust.  It is used in paint, gasoline, pottery glazing, and some metal jewelry.  Lead can find its way into our bodies through contaminated soil, household dust, drinking water, eating food grown in contaminated soul, or a dozen other unknown and little ways.

In adults, lead can cause increased blood pressure, infertility, nerve disorders, muscle and joint pain, and irritability, as well as interfering with your memory and ability to concentrate.  Cumulative life time exposure to lead can also increase the risk of cataracts. Occupations such as welding, renovation and remodeling, smelters, firing ranges, and assembly line workers, manufacturers of car batteries and maintenance workers for bridges and water towers are at increased risk for lead exposure.
 
Lead is even more dangerous for children, particularly under the age of five.  Lead levels tend to be highest in two-year-olds.  One reason for this is the toddler’s tendency to put high quantities of things in their mouths as a method of exploring their world.  Black children and children in low-income homes carry the highest risk.  Large amounts of lead consumption leads to anemia, severe stomach pain, muscle weakness and brain damaged.  Even small amounts have been linked to lower IQ scores.

Symptoms of severe lead poisoning can include abdominal pain, patient complaint of a metallic taste in the mouth, anorexia, vomiting, diarrhea, headache, stupor, renal failure, convulsions, and coma.

Treatment includes establishing adequate urine flow as a method of lead removal, and controlling convulsions with diazepam as necessary.  Calcium disodium edetate and dimercaprol are given to facilitate the removal of the lead from the body through the urine.

After initial treatment, penicillamine is given orally to children for 3-6 months and to adults for up to 2 month.  However, it is crucial that patients receiving penicillamine therapy are monitored weekly for adverse reactions.  Adverse reactions could include: diffuse rashes, edema, proteinuria, and neutropenia.  Penicillamine is also contraindicated in patients with a history of penicillin sensitivity and renal disease.

Succimer is an additional option.  Common side effects include decreased appetite, joint pain, decreased urination, diarrhea, dizziness and drowsiness or headache.
Nevertheless, it is important to note that although treatments are available to help with lead removal the effects of lead poisoning, it can not reverse the effects on the child’s IQ.  Prevention is the number one priority.  The source of the lead exposure should be identified and eliminated.

A simple blood test during pediatric visits for high-risk groups should be encouraged to detect blood levels of lead with the body.  Also, encourage families to have their older homes screened for lead paint as well as assessing their tap water and soil for lead contaminants.  Any sources of lead paint should be cleaned or addressed by a trained professional.
A little prevention can go a long way.  So, there is a point of gratitude to toy recalls amidst the busiest toy giving season of the year.

Resource:

National Institute of Environmental Health Sciences. Lead and Your Health.  April 2005 http://www.ni ehs.nih.gov/health/topics/agents/lead/docs/lead.pdf  Accessed: November 2007

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