Lead Toxicity Human Health Effects

1
Lead Toxicity Human Health Effects

• Board
• Council of Governments
• April 14, 2004
• Washington, DC
• Georges C. Benjamin, MD, FACP
• Executive Director
• American Public Health Association

2
Where It Comes From?

• Naturally occurring element in the environment
• 40 of US Homes have lead based paint
• In these homes 25 are kids under age 6
• Dust, dirt paint chips
• Water (20) Usually lead pipes or solder
• Imported Lead glazed dishes, food cans
• Some imported candy some folk remedies

60 of exposure if heavy mixed formula used
3
1977 Public Health Success Story!

• Unleaded Gas
• Solders pipe
• House paint

4
Where It Goes?

• Gets into the body by ingestion or inhalation
• Lead is confused by the body as iron, calcium etc
• Calcium is an essential nutrient used for
  cellular function strong bones
• Absorbed lead goes to bones (years) where it is
  stored and into many types of cells where it
  disrupts cell function
• Absorption increased during pregnancy
• It can come back out of growing bones into the
  blood often during pregnancy, growth spurts,
  menopause

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What It Does?

• Anemia
• Developmental delay
• Mental / cognitive disorders
• Kidney dysfunction causing hypertension
• Muscle aches
• Miscarriages
• Coma death in doses

No useful physiologic purpose
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Who Is At Risk?

• No proven safe level
• Infants those lt6y/o
• Growing
• Increased absorption
• Everything goes to mouth
• Pregnant women fetus
• Brest feeding women can pass to child if they
  have increased lead
• Adults especially some workers (battery,
  smelters, painters)

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How Do We Stop It?

• Prevention
• Flush pipes filters
• Lead abatement
• Avoidance of high risk
• Environmental testing remediation Water
  Action 15 ppb

• This is a preventable condition!!!!

8
What Can We Do About It?

• Detection
• Universal vs. targeted blood vs. risk
  questionnaires
• Childhood blood screening (Vena puncture vs.
  finger stick)
• Ages 12 24 months
• Symptoms
• Reportable to public health authorities

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Treatment

• Changing better therapies/knowledge
• lt10 ug/dL blood level
• gt10 ug/dL - 25ug/dL blood level (2 in US)
• 35 ug/dL 50 ug/dL blood level (Symptoms)
• gt 70 ug/dL Medical emergency
• Evaluate exposure
• Environmental remediation
• Remove from exposure
• Medication - Chelation therapy
• Older ones have side effects
• Newer ones can often be given as outpatient

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• Georges C. Benjamin, MD, FACP
• Executive Director
• American Public Health Association
• WWW.APHA.ORG

Public Health Prevent, Protect, Promote