Lead Poisoning
Although it is far less common since paint containing lead pigment was banned in 1977 and lead was eliminated from most gasoline, lead poisoning (plumbism) is still a major public health problem in U.S. cities on the East Coast. Workers in industries that handle lead are at risk of lead poisoning, as are children who live in older houses that contain peeling lead paint or lead pipes. Young children may eat enough paint chips to develop symptoms of lead poisoning. Lead affects many parts of the body, including the brain, nerves, kidneys, liver, blood, digestive tract, and sex organs. Children are particularly susceptible because lead produces the most damage in nervous systems that are still developing.
If the level of lead in the blood is high for days, symptoms of sudden brain damage (encephalopathy) usually develop. Lower blood levels that are sustained for longer periods of time sometimes produce long-term intellectual deficits.
Symptoms and Diagnosis
Many people with mild lead poisoning have no symptoms. Symptoms that do occur usually develop over several weeks or longer. Sometimes symptoms flare up periodically.
Typical symptoms of lead poisoning include personality changes, headaches, loss of sensation, weakness, a metallic taste in the mouth, uncoordinated walking, poor appetite, vomiting, constipation, crampy abdominal pain, bone or joint pains, and anemia (see Section 14, Chapter 172). Kidney damage often develops without symptoms.
Young children may become cranky and play less frequently over the course of several weeks. Encephalopathy can then begin suddenly and worsen over the next several days, resulting in persistent, forceful vomiting; confusion; sleepiness; and, finally, seizures and coma.
Adults often develop loss of sex drive, infertility, and, in men, erectile dysfunction (impotence). Encephalopathy rarely develops in adults.
Some symptoms may diminish if exposure to lead is stopped, only to worsen again if exposure is resumed.
Lead poisoning is diagnosed with a blood test. Adults whose jobs involve handling lead need frequent blood tests. Children living in communities with many older houses, where peeling lead-based paint is common, should also undergo blood tests for lead. In children, bone and abdominal x-rays often show evidence of lead poisoning.
Treatment and Prognosis
Treatment consists of stopping exposure to lead and removing accumulated lead from the body. Doctors remove lead from the body by giving drugs that bind with the lead (chelation therapy), allowing it to pass into the urine. All drugs that remove lead work slowly and can cause serious side effects.
People with mild lead poisoning are given succimer by mouth. People with more serious lead poisoning are treated in the hospital with injections of chelating drugs, such as dimercaprol, succimer, penicillamine, and edetate calcium disodium. Because chelating drugs also can remove beneficial minerals, such as zinc, copper, and iron, from the body, the person often is given supplements of these minerals.
Even after treatment, many children with encephalopathy develop some degree of permanent brain damage. Kidney damage is also sometimes permanent.
Prevention
Commercially available kits can be used to test household paint, ceramics, and water supplies for lead content. Dusting affected windowsills weekly with a damp cloth removes some dust that could contain lead from paint. Chipped leaded paint should be repaired. Larger renovation projects to remove leaded paint can release large quantities of lead into the house and should be done professionally. Commercially available faucet filters can remove most lead from drinking water.
| 
