Medical Management of Lead-Exposed Adults

Despite a decrease in blood lead levels (BLL) in the general population, thousands of people in the U.S. still work under conditions that can cause BLLs high enough to harm their health. While lead poisoning does occur in adults outside the workplace, most adults are exposed to lead on the job. The Occupational Safety and Health Administration (OSHA) lead standards provide some requirements for health professionals who care for lead-exposed workers, but they are based on outdated scientific information. Much has been learned about lead's harmful health effects since OSHA passed the first lead standard in 1978. As a result, the Occupational Lead Poisoning Prevention Program (OLPPP) has updated our own guidelines for health care professionals.

Medical Guidelines for Lead-Exposed Workers

• OLPPP now considers a level of 5 µg/dL to be elevated in adults.

• OLPPP recommends workers be removed from lead exposure if they have two BLLs of 20 µg/dL or higher or one BLL of 30 µg/dL.

• If worker is pregnant, OLPPP recommends worker be removed from lead exposure at 5 µg/dL.

• Please refer to CDC Guidelines for Pregnant and Lactating Women (PDF, 4.3 MB). See pages 65-66 for occupational guidance.

• To notify employer, use Template for Letter to Employer re: Workplace Lead Exposure (Word).

• Depending on a worker's other health-related conditions, medical removal may be needed at lower BLLs.

Resources

For more information regarding medical management of lead-exposed workers, see the following OLPPP resources:

• If you are a health care professional and would like more information, please contact our public health physician at AdultLead@cdph.ca.gov

• Management Guidelines For Blood Lead Levels in Adults (PDF) - brief table format (2019)

• Overview of Adult Occupational Lead Poisoning in California - free online CME course

• for occupational medicine providers (2017)

• for general practitioners (2016)

• Medical Guidelines for the Lead-Exposed Worker (PDF) – 2009

• Recommendations for Medical Management of Adult Lead Exposure - journal article abstract (2007)

• Lead in Ayurvedic Remedies: A Warning to Providers (PDF) - fact sheet (2019)

See all OLPPP publications for health care professionals here.

What Health Care Professionals Need to Know

OLPPP works to identify, mitigate, and prevent adult lead poisoning throughout California. OLPPP relies on the help of Health Care Providers to do this work through the following:

• Recognize potential lead poisoning cases.

• Always ask adult patients about their work. Know the signs and symptoms of lead poisoning and be alert to possible lead exposure in your patients.

• Order a BLL test if you suspect lead exposure or the patient has had an elevated BLL in the past. If testing is part of employee medical surveillance, samples are required to be analyzed by a laboratory which meets OSHA accuracy requirements in blood lead proficiency testing. Use the sample BLL testing lab requisition form (PDF) to ensure that you collect and send the required demographic information. This information is crucial for public health surveillance of lead exposure in California.

• Provide appropriate medical management based on an individual's health status and BLL result. See OLPPP medical guidelines above.

• Consider referring patients to a provider experienced in managing lead poisoning and/contacting OLPPP for more information about work-related lead poisoning and specialized care.

See our free CMEs, Overview of Adult Occupational Lead Poisoning in California, for recently updated information: for occupational medicine providers | for general practitioners.