Recommendations for Medical Management of Adult Lead Exposure

By Kosnett, Michael J.; Wedeen, Richard P. et al. | Environmental Health Perspectives, March 2007 | Go to article overview

Recommendations for Medical Management of Adult Lead Exposure


Kosnett, Michael J., Wedeen, Richard P., Rothenberg, Stephen J., Hipkins, Karen L., Materna, Barbara L., Schwartz, Brian S., Hu, Howard, Woolf, Alan, Environmental Health Perspectives


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 [micro]g/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 [micro]g/dL or if two successive blood lead concentrations measured over a 4-week interval are [greater than or equal to] 20 [micro]g/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 [micro]g/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 [micro]g/dL, and semiannual blood lead measurements when sustained blood lead concentrations are < 10 [micro]g/dL. It is advisable for pregnant women to avoid occupational or avocational lead exposure that would result in blood lead concentrations > 5 [micro]g/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. Key words: adult lead exposure, blood lead, chelation, medical management, medical surveillance, pregnancy. Environ Health Perspect 115:463-471 (2007). doi:10.1289/ehp.9784 available via http://dx.doi.org/ [Online 22 December 2006]

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As a likely consequence of its capacity to interfere with biochemical events present in cells throughout the body, inorganic lead exerts a wide spectrum of multisystemic adverse effects. These health impacts range from subtle, subclinical changes in function to symptomatic, life-threatening intoxication. In recent years, research conducted on lead-exposed adults has increased public health concern over the toxicity of lead at low dose. These findings support a reappraisal of the levels of lead exposure, sustained for either short or extended periods of time, that may be safely tolerated in the workplace. In this article we offer health-based recommendations on the management of lead-exposed adults aimed at primary and secondary prevention of lead-associated health problems. As noted in the introduction to this mini-monograph (Schwartz and Hu 2007) the authors of this article are an independent subgroup of an expert panel (8 of 13 members) originally convened by the Association of Occupational and Environmental Clinics (www.aoec.org) to address these management issues. In deriving the recommendations in this article, we took note of a body of literature that establishes the potential for adverse health effects at blood lead concentrations or exposure levels permissible under current workplace regulations established in the 1970s by the U.S. Occupational Safety and Health Administration (OSHA). These regulations generally require removal from lead exposure when whole-blood lead concentrations exceed 50 or 60 [micro]g/dL. These values are considerably above blood lead concentrations of the general population of the United States, which had a geometric mean of 12.8 [micro]g/dL in the late 1970s (National Center for Health Statistics 1984), and a recent value of 1.45 [micro]g/dL [U.S. Centers for Disease Control and Prevention (CDC) 2005]. …

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