Lead Poisoning in Adults

Adult lead poisoning is usually chronic and preventable. The exposure may come from battery or ammunition work, construction, painting, firearm use, contaminated water, imported spices or cosmetics, traditional remedies, ceramics, or a retained bullet. Lead dust can also travel home on clothing, shoes, skin, or a vehicle and expose family members. The presentation is easy to mislabel. Fatigue and poor concentration may look psychiatric, abdominal cramping and constipation may look gastrointestinal, and anemia may be attributed to iron deficiency. The combination of an exposure history with abdominal colic, hypertension or kidney dysfunction, anemia, or a predominantly motor neuropathy should prompt consideration of lead toxicity. A venous whole-blood lead level confirms the exposure. The first treatment is not a chelating drug; it is finding and stopping the source. Encephalopathy, seizures, acute kidney injury, severe abdominal symptoms, or a very high blood lead level changes the situation to an emergency requiring immediate toxicology guidance.