Lead poisoning: A disease for the next millennium

The decline in the prevalence of childhood lead poisoning is a public health success story. However, nearly a million preschool-aged children in the United States alone have elevated BPb levels. Toxicity correlates with BPb concentrations and progresses from biochemical and subclinical abnormalities at levels around 10 μg/dL to coma and death at levels over 100 μg/dL. Treatment consists of the elimination of exposure, interruption of the pathway into the child, modification of diet to ensure adequate essential metal intake (calcium, iron), and on occasion, chelation therapy. The identification of children with the most lead poisoning depends on screening for exposure (questionnaire) or evidence of increased absorption (BPb test). Follow-up is crucial to maximize the effectiveness of any intervention.