Lead Health Effects Warren Silverman MD

Occupational exposure Construction workers Steel welders Bridge reconstruction workers Firing range instructors and cleaners Painters Remodelers and refinishers Foundry workers Scrap metal recyclers Auto repairers Cable splicers

Hobbies Casting bullets or fishing sinkers Home remodeling Target shooting at firing ranges Lead soldering Auto repair Stained glass making Glazed pottery making

Substance Use Some folk remedies Some "Health Foods" Moonshine whiskey Ceramicware

Take Home Lead Lead particles or dust can be brought into the home and family vehicle on work clothes and equipment. Since blood borne lead crosses the placenta, a pregnant woman with an elevated blood lead level may expose her fetus to the toxic effects of lead. Lead poisoning in children is especially dangerous because it can cause learning problems and serious illness. If young children live in the home and a parent works with lead, they should be tested.

Lead serves no biological function in the human body The OSHA Lead in Construction Standard requires medical surveillance employees who are occupationally exposed to lead at or above the action level of 30 μg/m3. initial medical surveillance, includes biological monitoring for blood lead levels and zinc protoporphyrin (ZPP). Employees exposed to lead at or about the action level for more than 30 days in a consecutive 12-month period shall be enrolled in a medical surveillance program that includes at least the following: detailed work history, medical history, and thorough physical exam, with attention to the neurological system, kidneys, teeth, gums, blood, blood pressure, heart, gastrointestinal system, and lungs.

Frequency of Medical Examination Medical examination for lead exposure is to be conducted: annually, if the blood lead level (BLL) has been greater than 40 μg/dL in the past 12 months; If signs and symptoms of lead exposure appear, and as otherwise deemed medically appropriate

Medical Examination A detailed work history and a medical history, with particular attention to past lead exposure (occupational and non-occupational), personal habits (smoking, hygiene), and past gastrointestinal, hematologic, renal, cardiovascular, reproductive and neurological problems; 1926.62(j)(3)(ii)(B) A thorough physical examination, with particular attention to teeth, gums, hematologic, gastrointestinal, renal, cardiovascular, and neurological systems. Pulmonary status should be evaluated if respiratory protection will be used; 1926.62(j)(3)(ii)(C) A blood pressure measurement;

Medical Testing 1926.62(j)(3)(ii)(D) A blood sample and analysis which determines: 1926.62(j)(3)(ii)(D)(1) Blood lead level; 1926.62(j)(3)(ii)(D)(2) Hemoglobin and hematocrit determinations, red cell indices, and examination of peripheral smear morphology; 1926.62(j)(3)(ii)(D)(3) Zinc protoporphyrin; 1926.62(j)(3)(ii)(D)(4) Blood urea nitrogen; and, 1926.62(j)(3)(ii)(D)(5) Serum creatinine; 1926.62(j)(3)(ii)(E) A routine urinalysis with microscopic examination; 1926.62(j)(3)(ii)(F) Any laboratory or other test relevant to lead exposure which the examining physician deems necessary by sound medical practice.

Removal Construction 1926.62 General industry 1910.1025 The employer shall remove an employee from work having an exposure to lead at or above the action level on each occasion that a periodic and a follow-up blood sampling test conducted pursuant to this section indicate that the employee's blood lead level is at or above 60 ug/100 g of whole blood The employer shall remove an employee from work having an exposure to lead at or above the action level on each occasion that the average of the last three blood sampling tests conducted pursuant to this section (or the average of all blood sampling tests conducted over the previous six (6) months, whichever is longer) indicates that the employee's blood lead level is at or above 50 ug/100 g of whole blood; provided, however, that an employee need not be removed if the last blood sampling test indicates a blood lead level at or below 40 ug/100 g of whole blood. The employer shall remove any employee from work when BLL results are greater than 50 mg/dL. An employee on medical removal may return to work with a BLL at or below 40 mg/dL or upon approval of the physician. Employees on medical removal shall be provided with up to 18 months of medical removal protection benefits on each occasional of removal due to BLL.

Medical Opinion Upon the finding or suspicion of exposure to lead, the employer shall provide the employee with a written medical opinion from the examining physician that includes at least: detected medical condition(s) placing employee at increased risk, recommended PPE, respiratory protection limitations, and blood lead levels. The physician’s medical opinion should not contain diagnoses unrelated to occupational exposure.

Neurological Effects Peripheral neuropathy Fatigue / Irritability Impaired concentration Hearing loss Wrist / Foot drop Seizures Encephalopathy

Gastrointestinal Effects Nausea Dyspepsia Constipation Colic Lead line on gingival tissue

Reproductive Effects Heme Synthesis Renal Effects Other Miscarriages/Stillbirths Reduced sperm count & motility Abnormal sperm Heme Synthesis Anemia Erythrocyte protoporphyrin elevation Renal Effects Chronic nephropathy with proximal tubular damage Hypertension Other Arthralgia Myalgia

>80 µg/dL, Between 40 and 80 µg/dL, Between 25 and 40 µg/dL, serious, permanent health damage may occur (extremely dangerous). Between 40 and 80 µg/dL, serious health damage may be occurring, even if there are no symptoms (seriously elevated). Between 25 and 40 µg/dL, regular exposure is occurring. There is some evidence of potential physiologic problems (elevated). Between 10 and 25 µg/dL, lead is building up in the body and some exposure is occurring

Medical removal in OSHA standard is 50

First, test each worker before they begin any work involving lead Then test that worker every month: For the first 3 months of testing, and Whenever the previous blood lead level was greater than 25 µg/dL (If the previous blood lead level was at least 50 µg/dL, a follow-up test within 2 weeks and medical removal is required), or Whenever an increase of at least 10 µg/dL from the previous test is observed After the first three months, continue testing every 2 months: When the blood lead levels have remained below 25 µg/dL for 3 months, and If an increase less than 10 µg/dL from the previous test is observed Test every 6 months: When the blood lead levels remain below 25 µg/dL for 6 months, and

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