History

The clinical picture associated with lead poisoning is vague. Symptoms are not specific enough to alarm the physician about lead toxicity. Most cases are currently identified through effective screening of the population at risk. However, patients with lead poisoning frequently have constipation, abdominal pain, and/or anorexia.

Gastrointestinal (GI) symptoms of lead poisoning include the following:

Anorexia
Vomiting
Constipation
Abdominal pain

Neurobehavioral changes observed in lead poisoning include the following:

Inattentiveness
Distractibility
Impulsiveness
Learning problems

Peripheral nervous system effects (rare in children) associated with lead poisoning include the following:

Weakness
Peripheral palsies

Physical Examination

No specific physical signs for lead poisoning are recognized, but patients may exhibit pallor (due to associated anemia) and hyperactivity.

Signs of increased intracranial pressure can include the following:

Impaired consciousness
Bradycardia
Hypertension
Respiratory depression
Papilledema
Coma

Differential Diagnoses

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Murata K, Iwata T, Dakeishi M, Karita K. Lead Toxicity: Does the Critical Level of Lead Resulting in Adverse Effects Differ between Adults and Children?. J Occup Health. 2008 Nov 6. [QxMD MEDLINE Link].
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Koller K, Brown T, Spurgeon A, Levy L. Recent developments in low-level lead exposure and intellectual impairment in children. Environ Health Perspect. 2004 Jun. 112(9):987-94. [QxMD MEDLINE Link].
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Mason LH, Harp JP, Han DY. Pb neurotoxicity: neuropsychological effects of lead toxicity. Biomed Res Int. 2014. 2014:840547. [QxMD MEDLINE Link]. [Full Text].
Agency for Toxic Substances and Disease Registry. Toxicological Profile for Lead. U.S. Department of Health and Human Services. Available at https://www.atsdr.cdc.gov/toxprofiles/tp13.pdf. Accessed: April 9, 2022.
Kim HC, Jang TW, Chae HJ, Choi WJ, Ha MN, Ye BJ, et al. Evaluation and management of lead exposure. Ann Occup Environ Med. 2015. 27:30. [QxMD MEDLINE Link]. [Full Text].
United States Department of Labor. Lead. Occupational Safety and Health Administration. Available at https://www.osha.gov/SLTC/lead/. Accessed: April 9, 2022.
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Weiss D, Tomasallo CD, Meiman JG, Alarcon W, Graber NM, Bisgard KM, et al. Elevated Blood Lead Levels Associated with Retained Bullet Fragments - United States, 2003-2012. MMWR Morb Mortal Wkly Rep. 2017 Feb 10. 66 (5):130-133. [QxMD MEDLINE Link]. [Full Text].
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Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, et al. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec. 59 (12):1282-1501. [QxMD MEDLINE Link]. [Full Text].
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Author

Mohamed K Badawy, MD, FAAP Assistant Professor of Emergency Medicine and Pediatrics, University of Texas Southwestern Medical School; Associate Medical Director, Division of Emergency Medicine, Children's Medical Center Dallas

Mohamed K Badawy, MD, FAAP is a member of the following medical societies: Academic Pediatric Association, Society for Academic Emergency Medicine, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory P Conners, MD, MPH, MBA, FAAP, FACEP Director, Division of Emergency Medicine, Children's Mercy Hospital; Associate Chair of Pediatrics, Professor of Pediatrics and Emergency Medicine, University of Missouri-Kansas City School of Medicine

Gregory P Conners, MD, MPH, MBA, FAAP, FACEP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Pediatric Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Stephen L Thornton, MD Associate Clinical Professor, Department of Emergency Medicine (Medical Toxicology), University of Kansas Hospital; Medical Director, University of Kansas Hospital Poison Control Center; Staff Medical Toxicologist, Children’s Mercy Hospital

Stephen L Thornton, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology

Disclosure: Nothing to disclose.

Additional Contributors

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Pediatric Lead Toxicity Clinical Presentation

History

Physical Examination

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