Lead toxicity

To evaluate for rebound (as lead stored in soft tissues and bone is released) and to determine whether additional chelation is indicated, a blood lead level should be taken 2 to 4 weeks after completion of chelation therapy.[59]World Health Organization. Guideline for clinical management of exposure to lead. 2021 [internet publication]. https://www.ncbi.nlm.nih.gov/books/NBK575284 http://www.ncbi.nlm.nih.gov/pubmed/34787987?tool=bestpractice.com This interval may be shorter in patients with high initial blood lead concentrations.[59]World Health Organization. Guideline for clinical management of exposure to lead. 2021 [internet publication]. https://www.ncbi.nlm.nih.gov/books/NBK575284 http://www.ncbi.nlm.nih.gov/pubmed/34787987?tool=bestpractice.com  

All patients with lead exposure should be monitored by periodic whole-blood lead tests.

In children, the frequency of testing is a function of blood lead levels. Children at or near levels appropriate for chelation should be tested at least monthly until a steady decline in blood lead is noted. At that point quarterly testing is required until the blood lead is below 3.5 micrograms/dL.

Adult patients should also be tested regularly until blood lead declines below 10 micrograms/dL. These declines suggest decreased exposure.

Children and adults should be monitored for complications, and all children with elevated lead levels require more intensive neurodevelopmental evaluation than is provided by routine developmental screening.