Recommendations for Medical Management of Adult Lead Exposure Michael J. Kosnett,1 Richard P. Wedeen,2 Stephen J. Rothenberg,3,4 Karen L. Hipkins,5 Barbara L. Materna,6 Brian S. Schwartz,7,8 Howard Hu,9 and Alan Woolf10 1Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA; 2Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey, USA; 3CINVESTAV-IPN (Centro de Investigaciones y de Estudios Avanzados-Instituto Politécnico Nacional), Merida, Yucatan, Mexico; 4National Institute of Public Health, Cuernavaca, Morelos, Mexico; 5Public Health Institute, Occupational Lead Poisoning Prevention Program, Richmond, California, USA; 6California Department of Health Services, Occupational Health Branch, Richmond, California, USA; 7Departments of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; 8Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; 9Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA; 10Program in Environmental Health, Division of General Pediatrics, Children's Hospital, Boston, Massachusetts, USA Abstract 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 µg/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 µg/dL or if two successive blood lead concentrations measured over a 4-week interval are ≥ 20 µg/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 µg/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 µg/dL, and semiannual blood lead measurements when sustained blood lead concentrations are < 10 µg/dL. It is advisable for pregnant women to avoid occupational or avocational lead exposure that would result in blood lead concentrations > 5 µg/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] This article is part of the mini-monograph "Lead Exposure and Health Effects in Adults: Evidence, Management, and Implications for Policy." Address correspondence to M. Kosnett, 1630 Welton St., Ste. 300, Denver, CO 80202 USA. Telephone: (303) 571-5778. Fax: (303) 571-5820. E-mail: Michael.Kosnett@uchsc.edu The findings and conclusions in this article are those of the authors and do not necessarily represent the views of CDHS. All other authors declare no competing financial interest. The participation of H.H. was supported in part by National Institute of Environmental Health Sciences grants R01 ES05257, R01 ES10798, and R01 ES07821, and Center grant ES0002. MJK is an independent consultant who has provided paid consultation to community groups, industrial corporations, and governmental agencies regarding the health effects of occupational and environmental exposure to lead. He received no funding from any party for his contributions to this manuscript. B.L.M. and K.L.H. are affiliated with the Occupational Health Branch, California Department of Health Services (CDHS) . Received 3 October 2006 ; accepted 21 December 2006. The full version of this article is available for free in HTML or PDF formats. |