Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM) 

Lead Toxicity
What Instructions Should Be Given to Patients?

Learning Objectives

Upon completion of this section, you will be able to

• identify steps patients with domestic exposures can take to reduce lead exposure
• identify steps patients with occupational exposures should take to reduce lead exposure.

Introduction

Domestic Environmental Exposures to Lead

People may be exposed to lead through a variety of sources including deteriorated paint, contaminated soil, water, or other products. For children (and adults) with domestic exposures, there may be multiple sources. Therefore, it is important to encourage patients to address all potential sources of lead and to continue blood lead monitoring to help confirm that the source(s) has been effectively eliminated. In all cases, patients should be advised to

• eliminate source(s) of lead exposure,
• flushing the standing water from the lines and faucet for a few minutes before use and using cold water for drinking may reduce exposure,
• maintain a diet high in calcium and iron, and
• continue to monitor blood lead levels.

It can be difficult for low-income patients to permanently address all lead hazards in their homes due to costs and/or landlord relationships (if they are renters). There are federal disclosure laws for potential renters/buyers that require landlords and sellers to disclose any known lead hazard. However, in many communities grants are available to help with lead hazard control. Additionally, there are many low-cost ways to temporarily reduce lead hazards in homes. The patient instruction sheets provide several helpful references.

Covering bare soil contaminated with lead in the yard with grass or other type of covering can reduce exposures. Guidelines are available from governmental and nongovernmental organizations to help health care providers instruct their patients in reducing home lead hazards (CEHN 1999). It is also important that residents wet-clean regularly, as children’s blood lead levels have been found to be directly correlated with levels of lead in dust in their homes (Lanphear et al. 1998).

Patient-friendly, lead resources on the web.

• ATSDR ToxFAQs and ToxFAQs-Chemical Agent Briefing Sheet (TosFAQs-CABS) answer the most frequently asked health questions about lead (http://www.atsdr.cdc.gov/tfacts13.html and http://www.atsdr.cdc.gov/cabs/lead/lead_cabs.pdf)
• EPA provides information about lead in paint, dust and soil and how to protect children from lead poisoning at www.epa.gov/lead/
• EPA’s “Lead in Your Home; A Parent’s Reference Guide” www.epa.gov/lead/pubs/leadrev.pdf
• The National Lead Information Center (NLIC), funded by EPA, the Centers for Disease Control and Prevention (CDC) and the Department of Housing and Urban Development (HUD), provides the general public and professionals with information about lead hazards and their prevention www.epa.gov/lead/pubs/nlic.htm or call 1-800-424-LEAD [5323).
• Health Departments and other agencies can provide copies of other materials that will be useful to patients with environmental lead exposures.

Occupational Exposures to Lead

OSHA requires that the patient speaks to employer about removal from exposure that can help avoid further exposure. These include

• administrative controls
• personal protective equipment
• engineering controls

Clinical Follow-Up

Patients should be reminded of the importance of scheduling follow-up medical surveillance (blood lead testing.)

Patients also need to understand when and why they should call their physician for further medical attention. In particular, they should know to have their blood lead monitored on an ongoing basis to confirm removal from the source of exposure.

The ATSDR’s patient education sheet on lead toxicity, included in this case study, provides a more detailed checklist that can be used to indicate which types of follow-up are relevant for a given patient.

Key Points

• Patients exposed to lead in their homes should take steps to reduce environment sources of lead.
• Patients exposed to lead at work should talk to their employers about removal from the source of lead, OSHA regulations for workplace safety, and medical surveillance.
• Patients should also avoid other potential sources of lead.
• A patient education sheet and prescribed follow up check list on lead toxicity is available.

Progress Check