Complications
Lead-induced anemia resolves promptly with decreased exposure and possibly chelation. If anemia is found, iron supplementation should be provided, as this decreases lead exposure and treats any coincident iron deficiency anemia.
Neurodevelopmental delay caused by intra-uterine and early childhood exposure does not improve with chelation therapy. The World Health Organization recommends calcium supplementation for pregnant women with a blood lead concentration of ≥5 micrograms/dL, who have or are likely to have inadequate calcium intake.[59]
For children who meet accepted criteria for attention-deficit disorder or attention-deficit/hyperactivity disorder, stimulant medication seems to be effective.
The rapidly increasing rates of autism spectrum disorder has led to increased concern about the possibility that lead is a contributor to this diagnosis, as well as the other well-documented neurodevelopmental effects of lead. However, studies are inconclusive or contradictory.[84][85][86]
Childhood lead exposure has been associated with long-term consequences in adult life, including lower cognitive function, decline in IQ, psychopathology, and low socioeconomic status.[52][53][54] Lifetime lead exposure can be expressed later in life, where it may accelerate the rate of decline in cognition.
Hypertension is not reversed by chelation therapy and must be managed according to the accepted guidelines for essential hypertension.
Patients with lead toxicity can develop coronary artery disease. This is not reversed by chelation therapy and requires separate management.
Patients with lead toxicity have increased stroke mortality. This is not prevented by chelation therapy, and primary stroke prevention measures are required.
Patients with lead toxicity can develop peripheral artery disease. This is not prevented or reversed by chelation therapy and requires separate management.
Childhood lead exposure has been associated with long-term consequences in adult life, including lower cognitive function, decline in IQ, psychopathology, and low socioeconomic status.[52][53][54] Lifetime lead exposure can be expressed later in life, where it may accelerate the rate of decline in cognition.
Based on epidemiologic evidence, assessing global cancer risk, the International Agency for Research on Cancer has classified inorganic lead compounds as 2A (probable human carcinogen).[87]
Lead is a potent toxin to the proximal renal tubules in the kidneys. Patients can develop renal Fanconi syndrome with phosphaturia, glucosuria, and aminoaciduria.[25] This usually responds to decreased lead exposure and chelation therapy.
A few patients may be left with chronic renal dysfunction after successful treatment of tubular dysfunction. These patients must be managed in accordance with usual guidelines for renal dysfunction and failure.
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