Our Water in Crisis: Assessing and Treating Lead Poisoning

MAY 24, 2016
This article was collaboratively written by Florence Emeka, PharmD, and Ayesha M. Khan, PharmD, BCPS. Dr. Emeka received her Doctor of Pharmacy degree from Chicago State University College of Pharmacy in 2016.
Lead contamination in drinking water extends far beyond the city of Flint, Michigan, which declared a health emergency over a year ago after discovering elevated concentrations of lead in its water source.
A recent analysis from the US Environmental Protection Agency revealed that between 2012 and 2015, approximately 350 school and daycare centers failed lead tests a total of about 470 times. There have been tremendous efforts across the nation to uncover and rectify this issue, but it’s also important for health care providers to address the possible physiological effects and treatment options for overexposure to lead. 

Lead toxicity is related to the uptake of lead into the major soft tissue organs. Because of physiological differences between adults and children, the rate of lead absorption varies 40% to 50% and 10% to 15%, respectively. Since pediatric populations can absorb up to 5 times more water-soluble lead than adults, they’re most susceptible to toxic blood lead level (BLL) exposure.1,2 
The CDC recommends public health action for children aged 1 to 5 years with BLLs >5 μg/dL. Currently, about half a million children in the United States met these criteria.3

Lead Poisoning Symptoms
Signs and symptoms of lead poisoning are variable and highly dependent upon duration of exposure.
Acute exposure is classified as lead poisoning that isn’t immediately recognized and presents with common symptoms like abdominal pain, constipation, joint pain, and headache. These “classic” symptoms make it easy to misdiagnose lead poisoning for other more common diagnoses.4 
Chronic exposure is classified as a BLL range of 30 μg/dL to 70 μg/dL, which could be caused by chronic or recurrent lead exposures. This type of exposure is associated with symptoms such as myalgia, fatigue, irritability, insomnia, anorexia, impaired short-term memory, and difficulty concentrating.4 
Any patient with lead toxicity can experience neurologic, hematologic, renal, gastrointestinal, and endocrine system damage. Even with these potential complications, however, many patients remain asymptomatic. Therefore, attaining a BLL is recommended for an accurate diagnosis in suspected patients.

Lead Poisoning Diagnosis
It’s important to diagnose lead poisoning as early as possible because most of the detrimental physiological effects are irreversible. If a BLL can’t be determined immediately, the following objective findings can be used to support a diagnosis of lead poisoning2:
  • Lead flecks in abdominal radiographs
  • Lead lines on long-bone radiographs

Ayesha Khan, PharmD, BCPS
Ayesha Khan, PharmD, BCPS
Ayesha M. Khan, PharmD, BCPS, is a clinical assistant professor of pharmacy practice at Chicago State University College of Pharmacy (CSU-COP) and maintains a practice site at Rush University Medical Center. She received her Doctor of Pharmacy from Midwestern University Chicago College of Pharmacy in 2012 and then completed a PGY-1 Pharmacy Practice Residency at The University of Toledo Medical Center in Toledo, Ohio.