eMedicine Specialties > Radiology > Pediatrics

Lead Poisoning: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Coauthor(s): Usama Munir, MBBS, FRCS, Orthopedic Surgeon, Department of Surgery, Whiston Hospital, UK; Ian Turnbull, MB, ChB, MD, DMRD, FRCR, Lecturer, Department of Radiology, University of Manchester; Consulting Neuroradiologist, Hope Hospital, Salford, Manchester and North Manchester General Hospital, UK; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Contributor Information and Disclosures

Updated: Feb 3, 2009

Intervention

Medicolegal Pitfalls

  • Failure to recognize lead poisoning might lead to irreversible neurologic deficit. The symptoms and signs of lead toxicity are subtle and easily overlooked, and the presenting clinical features are nonspecific. The radiologist may be the first to suggest the diagnosis when conventional radiographs are reviewed.
  • In acute lead encephalopathy, brain edema occurs predominantly in the cerebellar vermis, which may act as a midline posterior fossa mass that occludes the fourth ventricle. This presentation may mimic that of brain tumor, which, if considered, may have disastrous consequences. The resultant transient obstructive hydrocephalus may require emergency drainage of cerebrospinal fluid. The hydrocephalus is transient, because the vermis edema subsides with medical treatment.
  • Pappas et al reviewed a case of lead poisoning in a 9-month-old child.85   Obstructive hydrocephalus was clinically and radiographically in evidence at the time of presentation. Edema of the cerebellum sufficient to cause obstruction of the ventricular system represented a particularly unusual presentation of this disease process. The investigators reviewed the literature for similar cases of lead encephalopathy.

Special Concerns

  • The persons most vulnerable to lead exposure are pregnant women, infants, and young children.
    • Pregnant women may transfer their body burden of lead to the growing fetus, because there is no placental barrier to heavy metals. Because lead crosses the placenta throughout pregnancy, the fetus is at risk of lead poisoning. BLLs tend to remain constant throughout pregnancy in women who were previously exposed to lead, even if they are no longer exposed to lead. Further lead exposure may result in harm to the fetus.
    • Lead in bone has implications for toxicology during pregnancy and lactation. Mobilization of lead from bone is likely to occur during periods of altered mineral metabolism. Because calciotropic factors determine the uptake and storage of lead in this compartment, changes in calcium-related regulatory factors are likely to affect lead compartmentalization.
    • Calcium metabolism significantly changes during pregnancy and lactation. Although relatively little is known of lead kinetics during these critical periods, bone lead may be mobilized and transferred to the more bioavailable compartment of the maternal circulation, with potential toxic effects on the fetus and mother.86
    • After birth, the child may continue to be exposed through the mother's milk.
    • Children are especially at risk for exposure to lead by playing with painted toys, by repeatedly ingesting non-food substances, and by engaging in similar activities.
  • The CDC has progressively lowered the BLLs of concern for lead exposure. Although the evidence is not definitive, several studies have demonstrated neurobehavioral impairment in lead-exposed children with BLLs as low as 10-14 mcg/dL, and there may not be a threshold. If 12% or more children in a given community have BLLs of 10 mcg/dL or higher (or if 27% or more of the housing stock is built before 1950), the CDC recommends universal screening; community-wide interventions should be considered by the appropriate agencies.
  • Lead poisoning is a preventable condition that may affect almost every system of the body. The toxic effects include subtle, common childhood symptoms, but lead poisoning may also cause severe illness, leading to death. Lead poisoning may mimic common childhood illnesses.
    • Clinicians need to be aware of the many sources of lead intoxication, particularly the use of folk remedies in ethnic minorities.
    • Symptoms of lead encephalopathy may involve focal signs that mimic those of a cerebral or cerebellar neoplasm. The importance of good history taking cannot be overemphasized.
    • Lead may have a deleterious effect on the CNS of a child when the BLL is as low as 0.48 µmol/L (10 mcg/dL). Lead-induced encephalopathy is a serious, end-stage disorder of lead poisoning that occurs when the BLL is around 3.86 µmol/L (80 mcg/dL).
    • In adults, lead poisoning predominantly affects the peripheral nervous system; it usually manifests as peripheral neuropathy.
  • Pearl and Boxt described a full-term asymptomatic child born with congenital lead poisoning secondary to maternal pica.87 Radiographic findings of an opaque cranial vault, lead lines, and delayed skeletal and deciduous dental development were noted at birth. After chelation therapy when the patient was 7 months old, radiographs revealed normal skeletal maturation. Tooth eruption did not occur until 15 months of age.
  • Hu studied the long-term consequences of childhood plumbism among 35 survivors of lead poisoning from the period 1930-1944.88 The participants were interviewed, along with 22 control subjects matched for age, sex, and town of residence. The results suggested that women with a history of childhood lead poisoning may be at risk for spontaneous abortions or stillbirths and for having children with significant learning disabilities.
 


More on Lead Poisoning

Overview: Lead Poisoning
Imaging: Lead Poisoning
Follow-up: Lead Poisoning
Multimedia: Lead Poisoning
References
Further Reading
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References

  1. Meyer PA, Brown MJ, Falk H. Global approach to reducing lead exposure and poisoning. Mutat Res. Jul-Aug 2008;659(1-2):166-75. [Medline].

  2. Interpreting and managing blood lead levels < 10 microg/dL in children and reducing childhood exposures to lead: recommendations of CDC's Advisory Committee on Childhood Lead Poisoning Prevention. MMWR Recomm Rep. Nov 2 2007;56:1-16. [Medline].

  3. Woolf AD, Goldman R, Bellinger DC. Update on the clinical management of childhood lead poisoning. Pediatr Clin North Am. Apr 2007;54(2):271-94, viii. [Medline].

  4. Flora SJ. Lead exposure: health effects, prevention and treatment. J Environ Biol. Jan 2002;23(1):25-41. [Medline].

  5. Piomelli S. Childhood lead poisoning. Pediatr Clin North Am. Dec 2002;49(6):1285-304, vii. [Medline].

  6. DeMichele SJ. Nutrition of lead. Comp Biochem Physiol A. 1984;78(3):401-8. [Medline].

  7. Carpenter DO. Effects of metals on the nervous system of humans and animals. Int J Occup Med Environ Health. 2001;14(3):209-18. [Medline].

  8. Clarkson TW. Metal toxicity in the central nervous system. Environ Health Perspect. Nov 1987;75:59-64. [Medline].

  9. Winder C, Garten LL, Lewis PD. The morphological effects of lead on the developing central nervous system. Neuropathol Appl Neurobiol. Mar-Apr 1983;9(2):87-108. [Medline].

  10. Otto DA, Fox DA. Auditory and visual dysfunction following lead exposure. Neurotoxicology. Summer-Fall 1993;14(2-3):191-207. [Medline].

  11. Kopp SJ, Barron JT, Tow JP. Cardiovascular actions of lead and relationship to hypertension: a review. Environ Health Perspect. Jun 1988;78:91-9. [Medline].

  12. Zou HJ, Ding Y, Huang KL, et al. Effects of lead on systolic and diastolic cardiac functions. Biomed Environ Sci. Dec 1995;8(4):281-8. [Medline].

  13. Lin JL, Lin-Tan DT, Hsu KH, Yu CC. Environmental lead exposure and progression of chronic renal diseases inpatients without diabetes. N Engl J Med. Jan 23 2003;348(4):277-86. [Medline].

  14. National Toxicology Program. Lead (CAS No. 7439-92-1) and Lead Compounds. National Toxicology Program of the US Department of Health and Human Services. Available at http://ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s101lead.pdf.

  15. International Agency for Research on Cancer. Inorganic and Organic Lead Compounds: Inorganic Lead Compounds (Group 2A); Organic Lead Compounds (Group 3). International Agency for Research on Cancer. Available at http://monographs.iarc.fr/ENG/Monographs/vol87/volume87.pdf.

  16. Silbergeld EK. Lead poisoning: the implications of current biomedical knowledge for public policy. Md Med J. Mar 1996;45(3):209-17. [Medline].

  17. Gittleman JL, Engelgau MM, Shaw J, et al. Lead poisoning among battery reclamation workers in Alabama. J Occup Med. May 1994;36(5):526-32. [Medline].

  18. Kaye WE, Novotny TE, Tucker M. New ceramics-related industry implicated in elevated blood lead levels in children. Arch Environ Health. May-Jun 1987;42(3):161-4. [Medline].

  19. CDC. Occupational and take-home lead poisoning associated with restoring chemically stripped furniture--California, 1998. MMWR Morb Mortal Wkly Rep. Apr 6 2001;50(13):246-8. [Medline].

  20. Whelan EA, Piacitelli GM, Gerwel B, et al. Elevated blood lead levels in children of construction workers. Am J Public Health. Aug 1997;87(8):1352-5. [Medline].

  21. Lussenhop DH, Parker DL, Barklind A, McJilton C. Lead exposure and radiator repair work. Am J Public Health. Nov 1989;79(11):1558-60. [Medline].

  22. Nunez CM, Klitzman S, Goodman A. Lead exposure among automobile radiator repair workers and their children in New York City. Am J Ind Med. May 1993;23(5):763-77. [Medline].

  23. Carney JK, Garbarino KM. Childhood lead poisoning from apple cider. Pediatrics. Dec 1997;100(6):1048-9. [Medline].

  24. Eisenberg A, Avni A, Grauer F, et al. Identification of community flour mills as the source of lead poisoning inWest Bank Arabs. Arch Intern Med. Oct 1985;145(10):1848-51. [Medline].

  25. Shannon M, Graef JW. Lead intoxication from lead-contaminated water used to reconstitute infantformula. Clin Pediatr (Phila). Aug 1989;28(8):380-2. [Medline].

  26. CDC. Lead poisoning associated with imported candy and powdered food coloring--California and Michigan. MMWR Morb Mortal Wkly Rep. Dec 11 1998;47(48):1041-3. [Medline].

  27. Browder AA. Lead poisoning from glazes. Ann Intern Med. Apr 1972;76(4):665. [Medline].

  28. CDC. Lead-contaminated drinking water in bulk-water storage tanks--Arizona and California, 1993. MMWR Morb Mortal Wkly Rep. Oct 21 1994;43(41):751, 757-8. [Medline].

  29. Dickinson L, Reichert EL, Ho RC, et al. Lead poisoning in a family due to cocktail glasses. Am J Med. Mar 1972;52(3):391-4. [Medline].

  30. Shannon M. Lead poisoning from an unexpected source in a 4-month-old infant. Environ Health Perspect. Jun 1998;106(6):313-6. [Medline].

  31. Ng R, Martin DJ. Lead poisoning from lead-soldered electric kettles. Can Med Assoc J. Mar 5 1977;116(5):508-9. [Medline].

  32. Baer RD, Garcia de Alba J, Cueto LM. Lead based remedies for empacho: patterns and consequences. Soc Sci Med. 1989;29(12):1373-9. [Medline].

  33. Cheng TJ, Wong RH, Lin YP, et al. Chinese herbal medicine, sibship, and blood lead in children. Occup Environ Med. Aug 1998;55(8):573-6. [Medline].

  34. Rahman A, Maqbool E, Zuberi HS. Lead-associated deficits in stature, mental ability and behaviour in children in Karachi. Ann Trop Paediatr. Dec 2002;22(4):301-11. [Medline].

  35. Biehusen FC, Pulaski EJ. Lead poisoning after ingestion of a foreign body retained in the stomach. N Engl J Med. Jun 21 1956;254(25):1179-81. [Medline].

  36. Fernando NP, Healy MA, Aslam M, et al. Lead poisoning and traditional practices: the consequences for worldhealth. A study in Kuwait. Public Health. Sep 1981;95(5):250-60. [Medline].

  37. CDC. Lead poisoning-associated death from Asian Indian folk remedies--Florida. MMWR Morb Mortal Wkly Rep. Nov 16 1984;33(45):638, 643-5. [Medline].

  38. CDC. Jin bu huan toxicity in children--Colorado, 1993. MMWR Morb Mortal Wkly Rep. Aug 27 1993;42(33):633-6. [Medline].

  39. CDC. Leads from the MMWR. Folk remedy-associated lead poisoning in Hmong children. JAMA. Dec 16 1983;250(23):3149-50. [Medline].

  40. CDC. Lead poisoning following ingestion of homemade beverage stored in a ceramic jug--New York. MMWR Morb Mortal Wkly Rep. Jun 2 1989;38(21):379-80. [Medline].

  41. Chan H, Billmeier GJ Jr, Evans WE, Chan H. Lead poisoning from ingestion of Chinese herbal medicine. Clin Toxicol. 1977;10(3):273-81. [Medline].

  42. McNiel JR, Reinhard MC. Lead poisoning from home remedies. Clin Pediatr (Phila). Mar 1967;6(3):150-6. [Medline].

  43. Ali AR, Smales OR, Aslam M. Surma and lead poisoning. Br Med J. Sep 30 1978;2(6142):915-6. [Medline].

  44. Moore C, Adler R. Herbal vitamins: lead toxicity and developmental delay. Pediatrics. Sep 2000;106(3):600-2. [Medline].

  45. Abu Melha A, Ahmed NA, el Hassan AY. Traditional remedies and lead intoxication. Trop Geogr Med. Jan 1987;39(1):100-3. [Medline].

  46. Al-Saleh I, Nester M, DeVol E, et al. Determinants of blood lead levels in Saudi Arabian schoolgirls. Int J Occup Environ Health. Apr-Jun 1999;5(2):107-14. [Medline].

  47. Sprinkle RV. Leaded eye cosmetics: a cultural cause of elevated lead levels inchildren. J Fam Pract. Apr 1995;40(4):358-62. [Medline].

  48. Esernio-Jenssen D, Donatelli-Guagenti A, Mofenson HC. Severe lead poisoning from an imported clothing accessory: "watch" out for lead. J Toxicol Clin Toxicol. 1996;34(3):329-33. [Medline].

  49. Blank E, Howieson J. Lead poisoning from a curtain weight. JAMA. Apr 22-29 1983;249(16):2176-7. [Medline].

  50. Mowad E, Haddad I, Gemmel DJ. Management of lead poisoning from ingested fishing sinkers. Arch Pediatr Adolesc Med. May 1998;152(5):485-8. [Medline].

  51. Dillman RO, Crumb CK, Lidsky MJ. Lead poisoning from a gunshot wound. Report of a case and review of the literature. Am J Med. Mar 1979;66(3):509-14. [Medline].

  52. Kikano GE, Stange KC. Lead poisoning in a child after a gunshot injury. J Fam Pract. Apr 1992;34(4):498-500, 502, 504. [Medline].

  53. Roberts JR, Landers KM, Fargason CA Jr. An unusual source of lead poisoning. Clin Pediatr (Phila). Jun 1998;37(6):377-9. [Medline].

  54. Eastwell HD. Elevated lead levels in petrol "sniffers". Med J Aust. Oct 28 1985;143(9 Suppl):S63-4. [Medline].

  55. Norman EH, Hertz-Picciotto I, Salmen DA, Ward TH. Childhood lead poisoning and vinyl miniblind exposure. Arch Pediatr Adolesc Med. Oct 1997;151(10):1033-7. [Medline].

  56. Perkins KC, Oski FA. Elevated blood lead in a 6-month-old breast-fed infant: the role ofnewsprint logs. Pediatrics. Mar 1976;57(3):426-7. [Medline].

  57. Miller MB, Curry SC, Kunkel DB, et al. Pool cue chalk: a source of environmental lead. Pediatrics. Jun 1996;97(6 Pt 1):916-7. [Medline].

  58. Gorospe EC, Gerstenberger SL. Atypical sources of childhood lead poisoning in the United States: A systematic review from 1966-2006. Clin Toxicol (Phila). Apr 11 2008;1-10. [Medline].

  59. Elliott P, Arnold R, Barltrop D, et al. Clinical lead poisoning in England: an analysis of routine sources of data. Occup Environ Med. Dec 1999;56(12):820-4. [Medline].

  60. Falk H. International environmental health for the pediatrician: case study of lead poisoning. Pediatrics. Jul 2003;112(1 Pt 2):259-64. [Medline].

  61. Grandjean P. International perspectives of lead exposure and lead toxicity. Neurotoxicology. Summer-Fall 1993;14(2-3):9-14. [Medline].

  62. MMWR. Fatal pediatric lead poisoning: New Hamphshire, 2000. MMWR Morb Mortal Wkly Rep. Jun 8 2001;50(22):457-9. [Medline].

  63. McDonald JA, Potter NU. Lead''s legacy? Early and late mortality of 454 lead-poisoned children. Arch Environ Health. Mar-Apr 1996;51(2):116-21. [Medline].

  64. Kaufmann RB, Staes CJ, Matte TD. Deaths related to lead poisoning in the United States, 1979-1998. Environ Res. Feb 2003;91(2):78-84. [Medline].

  65. Cleveland LM, Minter ML, Cobb KA, Scott AA, German VF. Lead hazards for pregnant women and children: part 1: immigrants and the poor shoulder most of the burden of lead exposure in this country. Part 1 of a two-part article details how exposure happens, whom it affects, and the harm it can do. Am J Nurs. Oct 2008;108(10):40-9; quiz 50. [Medline].

  66. Hwang YF, Strickland GT, Chang NK, Beckner WM. Chronic industrial exposure to lead in 63 subjects. I. Clinical and erythrokinetic findings. Southeast Asian J Trop Med Public Health. Dec 1976;7(4):559-68. [Medline].

  67. Wong VC, Ng TH, Yeung CY. Electrophysiologic study in acute lead poisoning. Pediatr Neurol. Mar-Apr 1991;7(2):133-6. [Medline].

  68. Dequanter D, Lefebvre JC, Takieddine M, et al. [An acute pseudo-cholecystitis]. Rev Med Brux. Oct 2001;22(5):439-41. [Medline].

  69. Sensirivatana R, Supachadhiwong O, Phancharoen S, Mitrakul C. Neonatal lead poisoning. An unusual clinical manifestation. Clin Pediatr (Phila). Aug 1983;22(8):582-4. [Medline].

  70. Albers JW, Bromberg MB. X-linked bulbospinomuscular atrophy (Kennedy''s disease) masquerading as lead neuropathy. Muscle Nerve. Apr 1994;17(4):419-23. [Medline].

  71. Mennel EA, John SD. Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures. Pediatr Radiol. Jan 2003;33(1):11-4. [Medline].

  72. Woolf DA, Riach IC, Derweesh A, Vyas H. Lead lines in young infants with acute lead encephalopathy: a reliable diagnostic test. J Trop Pediatr. Apr 1990;36(2):90-3. [Medline].

  73. Hu H, Milder FL, Burger DE. X-ray fluorescence measurements of lead burden in subjects with low-levelcommunity lead exposure. Arch Environ Health. Nov-Dec 1990;45(6):335-41. [Medline].

  74. Ahlgren L, Liden K, Mattsson S, Tejning S. X-ray fluorescence analysis of lead in human skeleton in vivo. Scand J Work Environ Health. JUN 1976;2(2):82-6. [Medline].

  75. Sachs HK. The evolution of the radiologic lead line. Radiology. Apr 1981;139(1):81-5. [Medline].

  76. Blickman JG, Wilkinson RH, Graef JW. The radiologic "lead band" revisited. AJR Am J Roentgenol. Feb 1986;146(2):245-7. [Medline].

  77. Reyes PF, Gonzalez CF, Zalewska MK, Besarab A. Intracranial calcification in adults with chronic lead exposure. AJR Am J Roentgenol. Feb 1986;146(2):267-70. [Medline].

  78. Benson MD, Price J. Cerebellar calcification and lead. J Neurol Neurosurg Psychiatry. Aug 1985;48(8):814-8. [Medline].

  79. Schroter C, Schroter H, Huffmann G. [Neurologic and psychiatric manifestations of lead poisoning in adults(case report and review of the literature)]. Fortschr Neurol Psychiatr. Oct 1991;59(10):413-24. [Medline].

  80. Perelman S, Hertz-Pannier L, Hassan M, Bourrillon A. Lead encephalopathy mimicking a cerebellar tumor. Acta Paediatr. Apr 1993;82(4):423-5. [Medline].

  81. Johnston MV, Nishimura A, Harum K, et al. Sculpting the developing brain. Adv Pediatr. 2001;48:1-38. [Medline].

  82. Trope I, Lopez-Villegas D, Lenkinski RE. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. Pediatrics. Jun 1998;101(6):E7. [Medline].

  83. Trope I, Lopez-Villegas D, Cecil KM, Lenkinski RE. Exposure to lead appears to selectively alter metabolism of cortical gray matter. Pediatrics. Jun 2001;107(6):1437-42. [Medline].

  84. Tutar HE, Atalay S, Uysalel A, et al. Recurrent pericardial effusion due to gunshot wound of the heart in ahemodynamically stable child--a case report. Angiology. Apr 1999;50(4):337-40. [Medline].

  85. Pappas CL, Quisling RG, Ballinger WE, Love LC. Lead encephalopathy: symptoms of a cerebellar mass lesion and obstructivehydrocephalus. Surg Neurol. Oct 1986;26(4):391-4. [Medline].

  86. Silbergeld EK. Lead in bone: implications for toxicology during pregnancy and lactation. Environ Health Perspect. Feb 1991;91:63-70. [Medline].

  87. Pearl M, Boxt LM. Radiographic findings in congenital lead poisoning. Radiology. Jul 1980;136(1):83-4. [Medline].

  88. Hu H. Knowledge of diagnosis and reproductive history among survivors of childhood plumbism. Am J Public Health. Aug 1991;81(8):1070-2. [Medline].

  89. al-Hazzaa SA, Krahn PM. Kohl: a hazardous eyeliner. Int Ophthalmol. 1995;19(2):83-8. [Medline].

  90. CDC. Lead poisoning associated with use of traditional ethnic remedies--California, 1991-1992. MMWR Morb Mortal Wkly Rep. Jul 16 1993;42(27):521-4. [Medline].

  91. Elinder CG, Alvestrand A. Environmental lead exposure and chronic renal disease. N Engl J Med. May 1 2003;348(18):1810-2; author reply 1810-2. [Medline].

  92. Gonzalez-Riola J, Hernandez ER, Escribano A, et al. Effect of lead on bone and cartilage in sexually mature rats: amorphometric and histomorphometry study. Environ Res. 1997;74(1):91-3. [Medline].

  93. Gulson BL, Jameson CW, Mahaffey KR, et al. Pregnancy increases mobilization of lead from maternal skeleton. J Lab Clin Med. Jul 1997;130(1):51-62. [Medline].

  94. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. Gunshot wounds: 2. Radiology. AJR Am J Roentgenol. Oct 1990;155(4):691-702. [Medline].

  95. Horing E, Radtke KU, von Gaisberg U. [Acute lead poisoning]. Dtsch Med Wochenschr. Feb 1 1991;116(5):175-8. [Medline].

  96. Kalra V, Gulati S, Chitralekha KT, et al. Plumbism--a mimicker of common childhood symptoms. Indian J Pediatr. Feb 2000;67(2):81-6. [Medline].

  97. Lanphear BP, Dietrich KN, Berger O. Prevention of lead toxicity in US children. Ambul Pediatr. Jan-Feb 2003;3(1):27-36. [Medline].

  98. Leighton J, Klitzman S, Sedlar S, et al. The effect of lead-based paint hazard remediation on blood lead levels of lead poisoned children in New York City. Environ Res. Jul 2003;92(3):182-90. [Medline].

  99. Lockitch G, Berry B, Roland E, et al. Seizures in a 10-week-old infant: lead poisoning from an unexpected source. CMAJ. Dec 1 1991;145(11):1465-8. [Medline].

  100. Lopes AA, Port FK. Environmental lead exposure and chronic renal disease. N Engl J Med. May 1 2003;348(18):1810-2; author reply 1810-2. [Medline].

  101. Marchetti C. Molecular targets of lead in brain neurotoxicity. Neurotox Res. 2003;5(3):221-36. [Medline].

  102. Matsumoto T, Fukaya Y, Yoshitomi S, et al. Relations between lead exposure and peripheral neuromuscular functions oflead-exposed workers--results of tapping test. Environ Res. May 1993;61(2):299-307. [Medline].

  103. Mojdehi GM, Gurtner J. Childhood lead poisoning through kohl. Am J Public Health. Apr 1996;86(4):587-8. [Medline].

  104. Rahbar MH, White F, Agboatwalla M, et al. Factors associated with elevated blood lead concentrations in children in Karachi, Pakistan. Bull World Health Organ. 2002;80(10):769-75. [Medline].

  105. Rogan WJ, Ware JH. Exposure to lead in children--how low is low enough?. N Engl J Med. Apr 17 2003;348(16):1515-6. [Medline].

  106. Rubens O, Logina I, Kravale I. Peripheral neuropathy in chronic occupational inorganic lead exposure: a clinical and electrophysiological study. J Neurol Neurosurg Psychiatry. Aug 2001;71(2):200-4. [Medline].

  107. Selevan SG, Rice DC, Hogan KA, et al. Blood lead concentration and delayed puberty in girls. N Engl J Med. Apr 17 2003;348(16):1527-36. [Medline].

  108. Shannon M. Severe lead poisoning in pregnancy. Ambul Pediatr. Jan-Feb 2003;3(1):37-9. [Medline].

  109. Shannon M, Graef J. Hazard of lead in infant formula. N Engl J Med. Jan 9 1992;326(2):137. [Medline].

  110. Smart A, Madan N. Public health. Surma: a cause for concern. Health Visit. Nov 1990;63(11):379-80. [Medline].

  111. Sood A, Midha V, Sood N. Pain in abdomen--do not forget lead poisoning. Indian J Gastroenterol. Nov-Dec 2002;21(6):225-6. [Medline].

  112. Stanley PC, Wakwe VC. Toxic trace metals in the mentally ill patients. Niger Postgrad Med J. Dec 2002;9(4):199-204. [Medline].

  113. Tuzun M, Tuzun D, Salan A, Hekimoglu B. Lead encephalopathy: CT and MR findings. J Comput Assist Tomogr. May-Jun 2002;26(3):479-81. [Medline].

  114. Vig EK, Hu H. Lead toxicity in older adults. J Am Geriatr Soc. Nov 2000;48(11):1501-6. [Medline].

  115. Wu PB, Kingery WS, Date ES. An EMG case report of lead neuropathy 19 years after a shotgun injury. Muscle Nerve. Mar 1995;18(3):326-9. [Medline].

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Further Reading

Guidelines and clinical trials:

Preventing lead poisoning in young children. Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Department of Health and Human Services (U.S.) - Federal Government Agency [U.S.]
Public Health Service (U.S.).  2005 Aug.  101 pages.  NGC:004567

Lead exposure in children: prevention, detection, and management. American Academy of Pediatrics.  2005 Oct.  11 pages.  NGC:004538

Interpreting and managing blood lead levels <10 micrograms/dL in children and reducing childhood exposures to lead: recommendations of CDC's Advisory Committee on childhood lead poisoning prevention. Centers for Disease Control and Prevention - Federal Government Agency [U.S.].  2007 Nov.  16 pages.  NGC:006029

Screening for elevated blood lead levels in children and pregnant women: recommendation statement. United States Preventive Services Task Force - Independent Expert Panel.  1996 (revised 2006).  12 pages.  NGC:005433

Penicillamine Chelation for Children With Lead Poisoning

The Combined Effect of 2,3-Dimercaptosuccinic Acid and Multi-Nutrients on Children in Lead Poisoning

Social Network Based Intervention to Reduce Lead Exposure Among Native American Children

Exposure, Dose, Body Burden and Health Effects of Lead

Randomized Study of Succimer (Dimercaptosuccinic Acid) on Growth of Lead-Poisoned Children

Does Lead Burden Alter Neuropsychological Development?

Lead Mobilization & Bone Turnover in Pregnancy/Lactation

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Keywords

lead poisoning, plumbism, lead exposure, chronic lead nephropathy, chronic tubulointerstitial nephritis, acute lead poisoning, chronic lead nephropathy, lead hypertension, pica, lead intoxication, blood lead level, BLL, lead hypertension, lead chelation, osteosclerotic metaphyseal dysplasia, OMD

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Institute of Ultrasound in Medicine, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Usama Munir, MBBS, FRCS, Orthopedic Surgeon, Department of Surgery, Whiston Hospital, UK
Disclosure: Nothing to disclose.

Ian Turnbull, MB, ChB, MD, DMRD, FRCR, Lecturer, Department of Radiology, University of Manchester; Consulting Neuroradiologist, Hope Hospital, Salford, Manchester and North Manchester General Hospital, UK
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Medical Editor

Beverly P Wood, MD, PhD, Professor Emerita, Departments of Radiology and Pediatrics, Division of Medical Education, Keck School of Medicine, University of Southern California; Professor of Clinical Radiology, Loma Linda University School of Medicine
Beverly P Wood, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Marta Hernanz-Schulman, MD, FAAP, Professor, Radiology, Radiological Sciences, and Pediatrics, Director, Department of Pediatric Radiology, Radiologist-in-Chief, Director, Department of Diagnostic Imaging, Vanderbilt University Medical Center, Vanderbilt Children's Hospital
Marta Hernanz-Schulman, MD, FAAP is a member of the following medical societies: American Institute of Ultrasound in Medicine and American Roentgen Ray Society
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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