Suspected lead poisoning

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway
  • Lead exposure is usually chronic and may be asymptomatic; there is no known safe blood lead concentration in children.
  • Main treatment is identify and remove the exposure source
    • paint dust/renovation
    • imported cosmetics/spices/remedies
    • water/pipework
    • occupational/hobby exposure
  • Use whole blood lead concentration (EDTA tube). Do not use hair/nail testing.

Assessment

  • Who to suspect / when to test
    • Children (especially 1–4 years): pica or marked hand-to-mouth behaviour; neurodevelopmental disorders; unexplained abdominal pain or constipation; headache; irritability; anaemia; faltering growth.
    • Pregnant women: any possible environmental or occupational exposure (e.g. paint stripping, renovation, imported products).
    • Adults: compatible symptoms (abdominal pain, constipation, neuropathy, fatigue, cognitive symptoms) or known occupational/hobby exposure.
  • Key exposure history
    • Pre-1970 housing; recent renovation, sanding or heat stripping of paint.
    • Peeling paint or contaminated soil.
    • Imported spices, cosmetics or remedies (e.g. kohl/surma).
    • Glazed ceramics or cookware.
    • Shooting ranges; fishing weights.
    • Battery manufacture/recycling; metal work; stained glass.
    • “Take-home” exposure via contaminated clothing.
  • Initial investigations
    • Whole blood lead concentration (EDTA tube).
    • FBC (look for anaemia).
    • Consider iron studies (iron deficiency increases lead absorption).
    • U&E / LFT if clinically indicated.
    • If accidental ingestion of a lead-containing object suspected: consider abdominal X-ray.
Unit conversion: 5 μg/dL ≈ 0.24 μmol/L   |   10 μg/dL ≈ 0.48 μmol/L

Primary care management

Always do (any Pb > 0.1 µmol/L / 2 µg/dL)
  • Identify and remove/abate the source of exposure.
  • Consider vulnerable household contacts (especially children/pregnancy).
  • Check and correct iron and/or calcium deficiency if present.
  • Contact NPIS if unsure about monitoring or exposure avoidance.
Blood Pb 0.1–0.23 µmol/L (2–4 µg/dL)
Not child/pregnant
  • No routine repeat required if exposure removed.
  • Repeat only if further suspected exposure.
Child or pregnant
  • Repeat blood Pb 4 weeks after removal from exposure.
  • Monitor every 1–3 months until below 0.1 µmol/L.
  • Contact NPIS for advice on monitoring frequency if exposure risk persists.
  • If level rises to ≥0.24 µmol/L, follow next section.
Blood Pb 0.24–2.2 µmol/L (5–45 µg/dL)
  • Contact local Health Protection Team (HPT) for source identification and abatement advice.
  • Remove from exposure where possible.
Child or pregnant
  • Notify Health Protection Team
  • Repeat blood Pb 2–4 weeks after removal from exposure.
  • Then repeat 2–12 weekly until <0.1 µmol/L (2 µg/dL), depending on clinical context and re-exposure risk.
Not child/pregnant
  • Notify Health Protection Team if ≥ 0.48 µmol/L (10 µg/dL).
  • Assess for symptoms.
  • Repeat blood Pb 2–4 weeks after removal from exposure.
  • If falling, repeat 1–6 monthly until <0.24 µmol/L, then 6–12 monthly until <0.1 µmol/L.
Blood Pb ≥2.2 µmol/L (≥45 µg/dL)
  • Discuss urgently with NPIS.
  • Consider hospital admission and possible chelation (specialist decision).
  • Notify Health Protection Team
If repeat blood Pb is not decreasing
  • Re-review exposure sources and ensure effective removal/abatement.
  • Involve local HPT.
  • If level rises to ≥2.2 µmol/L (45 µg/dL), treat as urgent and escalate.
Key Contacts
  • NPIS (TOXBASE): 0344 892 0111
  • Health Protection Team (D&G): 01387 272724 (Option 6)
  • Email: dg.hpt@nhs.scot

Editorial Information

Last reviewed: 16/02/2026

Next review date: 16/02/2028

Version: 1.0

Reviewer name(s): Ewan Bell.