Lead
Medical Treatment
5-25 ug/dL: Pre to Mild Lead Poisoning
Solution: Lead abatement in the home and dietetic therapy rich in calcium and iron, low in fat.
Fats readily absorb lead. When the body recognizes high levels of calcium and iron, it absorbs less of the lead substitute. As lead levels decline, bone tissue will release stored lead to gain equilibrium. As the level of lead in the whole body declines, the body naturally steps up absorption of calcium and iron, thus the importance of lead abatement early-on.
25-45 ug/dL: Moderate Lead Poisoning
Solution: Aggressive lead abatement and dietetic therapy.
If blood levels persist, drug therapy (chelation) commences. Drugs such as succimer may be taken orally on an outpatient basis. Possible side effects may include low fever and nausea. Chelation drugs bind with lead in the blood stream, thus preventing absorption and aiding excretion.
45-70 ug/dL: Moderately-Severe Lead Poisoning (without encephalopathy
symptoms)
Solution: Aggressive chelation is required using heavier oral dosage of succimer on a declining schedule.
Monitoring as an inpatient which will also insure 100% lead abatement. Alternatively CaNaEDTA may be injected intramuscularly or infused intravenously over a 5 day period. Further lead testing will decide need to repeat chelation. Bowel decontamination may be necessary.
70+ ug/dL: Severe Lead Poisoning (also at lower lead levels when
encephalopothy is present)
Solution: Initiate inpatient chelation with BAL intramuscular injection.
Second injection in 4 hours followed with CaNaEDTA intravenously over 2-4 days. BAL may be injected daily depending on severity. Suspend chelation for 3 days, test blood lead levels, and repeat the 5 day regimen as needed. This process will continue until clinically stable.
Penicillamine is an alternative oral drug with a higher toxicity and side effect profile. It would be used when unacceptable reactions to EDTA and succimer have occurred.
______________ Developed by Jerry Hash
Extension Housing Associate
Biosystems and Agricultural Engineering Department
University of Kentucky Cooperative Extension Service
Lexington, Kentucky 40546-0276.