Health and Environmental

Impacts of Lead
,Occupational and environmental
Sources of Exposure

1- gasoline additives, paints, and solder in cans.

2- Approximately 70% of lead consumption
worldwide is for batteries
3- Ammunition consumes about 6% of lead
produced worldwide, while the remainder is
required for the production of other lead-bearing
products including solder, plastics, cable
sheathing. Lead is highly recyclable.
4- leaded glass
5-shielding material in power generation units.
6-its use in equipment to avoid interruption of electrical
power systems in hospitals and computer and
telecommunications networks
lead persists in the environment because it does not
undergo any degradation. Therefore, it continues to be a
source of exposure to humans.
leaded paint was shown to be a major cause of
lead poisoning in small children exposed by
ingestion of peeling paint on interior surfaces.
There are estimates by the World Health
Organization that 15 to 18 million children
have been damaged by lead in developing
countries.
 Lead oxides are formed on cooling of the
fumes in the air. Oxides and suboxides are
biologically active forms of lead that are
readily inhaled and absorbed.
7-Lead is an effective protection against high-
energy radiation and a principal constituent of
shielding materials against radiation,
including x-rays.
Another source of excessive exposure to lead that
is related to certain cultural uses is lead present in
some herbal, traditional folk medicines used by
East Indian, Indian, Middle Eastern, West Asian,
and Hispanic cultures. Lead added to these folk
medicines as therapeutic agents .
They are used against a wide spectrum of signs
and symptoms including gastrointestinal
symptoms, arthritis, and menstrual cramps and
have also been administered to children during
teething.
Also used as cosmetics to obtain a blue eye
shadow in both adults and children has also
been associated with elevated blood lead levels
and is one important environmental source of
lead exposure.
Cigarette smoking is a source of lead exposure
not only for the smoker but also for others living
in the household and has been shown to be
associated with higher blood lead levels in
children.
Lead absorption is known to be influenced by dietary
intake of several substances including calcium,
phosphorus, iron, vitamin D, and fat.. Calcium and
phosphorus have been shown to reduce absorption of
lead from the gastrointestinal tract. Vitamin C and
thiamine, as well as thiamine in combination with
zinc or vitamin E, have been demonstrated to
counteract some of the toxic effects of lead in
experimental studies.
Lead Poisoning in Children
Childhood lead poisoning is considered a major
public health problem and is known as the most
serious environmental hazard to children. Lead
associated with serious effects on childhood
cognitive and other neurobehavioral
development. abnormal effects can be detected in
both the growing child and unborn fetus.
Children are more susceptible to the toxic effects
of lead than adults. The developing nervous
system is particularly vulnerable to lead toxicity,
which can affect various functions of the brain.
Permanent damage may result.
the fetus can be seriously threatened by lead
exposure derived from the mobilization of
maternal skeletal lead stores that had accumulated
over years, even if the mother is not currently
exposed to lead
this realization has prompted greater attention to
the importance of reducing lead exposure in girls
and women as well as the consideration of
whether prepregnancy screening of women for
current and prior lead exposure may be of value
for secondary prevention .
Some evidence exists to show that calcium
supplementation can reduce maternal bone
resorption during pregnancy as well as fetal lead
exposure. It would seem mandatory that the
goal of all lead poisoning prevention
activities should be to reduce children's
blood levels and those of women of
childbearing age to significantly below 10 µg
per Dl.
Of most importance with regard to new methods
is noninvasive K-x-ray fluorescence (KXRF),
which has been designed to measure lead levels
in peripheral bones (such as the tibia, patella, and
calcaneus) as markers of skeletal lead burden .
Biochemical Aspects of Lead
Toxicity

Inhibition of delta-aminolevulinic acid dehydratase

(ALA-D) and ferrochelatase, two enzymes in the
biosynthetic pathway of heme.
ALA-D is a most sensitive indicator of
both acute and chronic effects of lead,
and its activity decreases with rising
blood lead levels.Determination of
ALA-D may emerge again as a future
sensitive indicator of early lead
toxicity
Increase in ZPP first occurs at blood lead levels of
about 15 to 20 µg per dL. ZPP may not be sensitive
enough to be used as a screening tool alone
.measurement of ZPP is therefore an indicator of a
lead-related effect on the erythropoietic tissue
averaged over a 3-month period ,whereas the blood
lead concentration reflects the more recent status of
lead absorption.Elevated levels of ZPP are also caused
by iron deficiency anemia, Therefore, iron deficiency
must be considered an important confounding factor in
interpreting ZPP test results.
Lead-related anemia is characteristically
normocytic and normochromic (or hypochromic)
and can, in most instances, be distinguished from
iron deficiency anemia, which is microcytic and
hypochromic. The serum iron level is often
normal or even elevated in lead poisoning.
Basophilic stippling of red blood cells, which
reflects the aggregation of ribosomes, was once
considered a classical sign of lead poisoning. This
phenomenon, however, occurs in many other
conditions and should be considered a nonspecific
finding, if other laboratory and clinical findings
are indicative of the disease.
Lead-induced effects on the biosynthesis of heme
are not limited to the hematopoietic system.
Signs and symptoms

Lead poisoning symptoms:

1.Headaches, irritability, fatigue,
difficulty sleeping, difficulty learning
or concentrating, aggressive
behaviour 2. Stomach pain,
constipation, vomiting, nausea,
weight loss 3. Hearing loss 4.
Anemia, unusual paleness, slowed
growth, seizures, coma, staggering
walk 5. Kidney damage, loss of
appetite 6. Reduced sensations 7.
Muscle weakness
Dense metaphyseal lines.
The brains of adults who were exposed to lead
as children show decreased volume, especially in
the prefrontal cortex
Control measures

1-adequate industrial hygiene practices in the

work environment 2-Biologic monitoring and
medical surveillance programs where the
concentration of lead in air is 30 µg per m3 or
higher for more than 30 days per year.
 Recommendations

The CDC recommends that screening for lead

poisoning be included in health care programs for
children under 72 months of age. This screening
is especially critical for children under 36 months
of age. Screening should start at six months of
age if the child is at risk for lead exposure.
Treatment

When lead poisoning has been diagnosed in a

person, the first course of action is to
discontinue exposure, which often is the only
required treatment, when the blood lead level
has reached 50 µg per dL or higher.
depends on the degree of blood lead elevation,
severity of clinical symptoms, biochemical and
hematologic disturbances, and type of exposure.
All these factors must be taken into consideration
in determining the necessity for chelation therapy.
EDTA(Ethylenediaminetetraacetic acid)
It is recommended that EDTA be given together
with BAL to prevent steep increase in blood lead
level following mobilization of lead from soft
tissues, which may aggravate symptoms, especially
neurologic symptoms. Some treatment regimens
include the administration of EDTA followed by a
course of oral succimer
Alertness should be maintained for possible
occurrence of cardiac arrhythmias, rash, and fever
and for evidence of renal damage (i.e., acute tubular
necrosis), which are potential side effects of the
treatment. Therefore, daily routine urine analyses
should be performed.
Because of mobilization of lead from various
tissue stores, the effectiveness of the treatment as
a means of lowering the initially high blood lead
level can only be examined approximately 5 to 7
days after the treatment course, when a blood
sample should be drawn for lead analysis. If a
second course is indicated, it should not be started
until after a recovery period of 7 to 10 days.
D-penicillamine has been used for several
decades in the treatment of lead poisoning. Like
succimer, it has the advantage of being an orally
administered drug that increases the urinary
excretion of lead.