Lead

Synonym/Acronym

Pb.

Rationale

To assess for lead toxicity and monitor exposure to assist in diagnosing lead poisoning.

Patient Preparation

There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings

Method: Atomic absorption spectrophotometry or inductively coupled plasma/mass spectrometry.

	Conventional Units	SI Units (Conventional Units × 0.0483)
Children and adults (CDC)	Less than 3.5 mcg/dL	Less than 0.17

CDC = Centers for Disease Control and Prevention.

Critical Findings and Potential Interventions ⬆ ⬇

Levels equal to or greater than 5 mcg/dL (SI: Greater than 0.24 micromol/L) indicate exposure above the reference level.
Levels equal to or greater than 45 mcg/dL (SI: Greater than 2.2 micromol/L) may require chelation therapy.
Levels greater than 70 mcg/dL (SI: Greater than 3.3 micromol/L) may cause severe brain damage and result in death.
Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.

Observe the patient for signs and symptoms of elevated lead levels to include headache, impaired hearing, weight loss, disturbances of the nervous system, severe stomach cramps, and anemia. The pediatric patient may also demonstrate delayed learning and delayed growth.

Overview ⬆ ⬇

Study type: Blood collected in a special lead-free royal blue or tan-top tube; a lavender-top [EDTA] tube is also acceptable; related body system: Circulatory/Hematopoietic, Digestive, Musculoskeletal, Nervous, and Urinary systems.

Lead is a heavy metal and trace element found in the environment. It is absorbed through the respiratory and gastrointestinal systems. It can also be transported from mother to fetus through the placenta. When there is frequent exposure to lead-containing items (e.g., paint, batteries, gasoline, pottery, bullets, printing materials) or occupations (mining, automobile, printing, and welding industries), lead poisoning can cause severe behavioral and neurological effects. The blood test is considered the best indicator of lead poisoning.

Indications ⬆ ⬇

Assist in the diagnosis and treatment of lead poisoning.

Interfering Factors ⬆ ⬇

Other Considerations

Contamination of the collection site and/or specimen with lead in dust can be avoided by taking special care to have the surfaces surrounding the collection location cleaned. Extra care should also be used to avoid contamination during the actual venipuncture.

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

Increased In

Heme synthesis involves the conversion of D-amino levulinic acid to porphobilinogen. Lead interferes with the enzyme that is responsible for this critical step in heme synthesis, amino levulinic acid dehydrase.

Anemia of lead intoxication
Lead encephalopathy
Metal poisoning

Decreased In

N/A

Nursing Implications, Nursing Process, Clinical Judgement ⬆

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

Discuss how this test can assist in detecting lead exposure.
Explain that a blood sample is needed for the test.

After the Study: Implementation & Evaluation Potential Nursing Actions

Avoiding Complications

Avoid herbal or traditional folk remedies that contain lead.

Treatment Considerations

Assess the environment for lead exposure, which can cause pediatric developmental delay; old leaded paint; contaminated soil of older homes; lead pipes; leaded ceramics or pottery used for food preparation and dining; old toys with lead.
Assess for lead exposure related to hobbies, which may disrupt mental acuity; the use of products containing lead; restoration that includes sanding or removal of old leaded paint; work-related lead exposure (mining, battery manufacturing, construction).
Modify diet and food purchasing habits to ensure absence of lead-contaminated kitchen cookware (ceramics), utensils, and foods; decrease environmental exposure by removing all decorative ceramics, toys, loose paint that contain lead.

Safety Considerations

Slow exposure to lead-based environment or products can cause irreversible damage over time to brain, kidneys, and nervous system and can lead to death.

Nutritional Considerations

Some canned goods and candies imported from other countries may have been produced using lead-contaminated ingredients (e.g., tamarind products packed in lead-glazed pots, minimally refined chili powder), lead-contaminated ink used to label candy packaging, or by poor manufacturing and storage processes. As appropriate, health-care providers should provide culturally sensitive education and discuss the safety issues related to consuming imported canned foods and candies.

Clinical Judgement

Consider how to overcome cultural nutrition choices to decrease lead exposure.

Follow-Up and Desired Outcomes

Understands that further testing may be necessary to evaluate or monitor progression of the disease process and determine the need for a change in therapy.
Agrees to institute environmental and dietary changes to prevent further lead exposure.