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REBECA C. GRACIA, PHARM.D., DABAT, is Director, North Texas Poison Center, Dallas. WAYNE R. SNODGRASS, M.D., PH.D., is Professor, Department of Pediatrics, The University of Texas Medical Branch, Galveston, and Medical Director, Southeast Texas Poison Center, Galveston.

Address correspondence to Dr. Gracia at the North Texas Poison Center, 5201 Harry Hines Boulevard, Dallas, TX 75235 (rgracia{at}parknet.pmh.org).

Purpose. Common sources of lead exposure, the primary clinical effects of lead toxicity, and current recommendations for managing lead toxicity, including chelation therapy, are reviewed. Summary. Common sources of lead exposure in children and adults include industrial and mining activities, paint, dust, soil, water, air, the workplace, food, trinkets, ethnic folk remedies, and cosmetics. The absorption and biological fate of lead are affected by a variety of factors, including an individual’s nutritional status, health, and age. Children with a blood lead concentration of >10 µg/dL and adults with a blood lead concentration of 45 µg/dL should undergo further evaluation. Symptoms and time to onset of symptoms postexposure may vary, and it can be difficult to identify the early, subtle neurologic effects of lead toxicity. The classic symptoms of lead toxicity generally correlate with blood lead concentrations of 25–50 µg/dL in children and 40–60 µg/dL in adults. Management of lead toxicity requires extensive risk assessment and caregiver education. Chelation is generally not indicated for adults with blood lead concentrations of <45 µg/dL because of the potential risk of adverse drug events and concerns about remobilized lead, and chelation for children with blood lead concentrations of <45 µg/dL remains controversial. Dimercaprol, edetate calcium disodium, and succimer are the three agents primarily used for chelation. Conclusion. Lead toxicity remains a significant public health concern. Elimination of elevated blood lead levels in children can be accomplished by educating appropriate health care providers and caregivers, recognizing potential lead sources, and adopting aggressive prevention and case management measures. Index terms: Absorption; Age; Antidotes; Blood levels; Case management; Dimercaprol; Drugs, body distribution; Edetate calcium disodium; Heavy metal antagonists; Lead; Pediatrics; Poisoning; Succimer; Toxicity