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The
OSHA Lead Standard (29 CFR 1910.1025) requires that employees exposed to
potentially hazardous levels of lead in the workplace be medically
evaluated. Report blood lead levels > 10 µg/dL to ADHS (A.R.S.
§36-1673).
Below is additional information regarding:
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Medical
Evaluation
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- JOB HISTORY
- with attention to lead
exposure
- MEDICAL HISTORY
- with special
attention to cardiovascular, gastrointestinal, hematologic, renal,
neurological, and reproductive systems
- PERSONAL HISTORY
- hygiene habits,
smoking, alcohol consumption, hobbies
- PHYSICAL EXAM
- with special attention
to cardiovascular, gastrointestinal, hematologic, renal,
neurological, and reproductive systems
- BLOOD PRESSURE READING PULMONARY STATUS: (if
exposure is to airborne lead)
- LABORATORY TESTING:
- Blood lead level (BLL)- immediately for pregnant women and workers
contemplating having children (BLL is best reflection of current
lead exposure)
- Hemoglobin, hematocrit, red cell indices, and
examination of peripheral smear morphology
- Zinc protoporphyrin level
(ZPP) or free erythrocyte protoporphyrin (FEP)
- Electrolytes,
bicarbonate
- BUN and serum creatinine
- Routine urinalysis with
microscopic exam
- Pregnancy test or semen evaluation, if requested by
the employee
- Special testing as needed: peripheral neuropathy (may
include nerve conduction velocities or consultative neurology
assessment)
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Signs and Symptoms |
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Mild to
Moderate Toxicity - anemia - lethargy - hypertension - abdominal
discomfort - vomiting - constipation - fatigue - irritability - headache -
muscular exhaustability - tremor - weight loss - male infertility -
impotence - risks for pregnant female: low birth weight and small head
circumference in newborn
Severe Toxicity - paresis or paralysis -
severe abdominal cramps - inhalation toxicity may lead to severe
respiratory distress - coma - death |
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Sources of Lead Exposure |
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Industries/Hobbies
- manufacturing/recycling batteries, metal, ammunition - smelters or
mines - radiator, battery, or automobile repair - soldering, welding, or
cutting metal - PVC plastics, crystal glass, or ceramics production -
producing or working with lead-based paint (marine, industrial,
artist's) - sanding or stripping of old paint - indoor shooting ranges -
making fishing sinkers
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Screen
Readable Version
Medical
Monitoring, Evaluation, & Reporting Recommendations
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RESPONSE |
| Worker assigned
to area where lead concentration in air is above action level: 30
ug/m3 lead in air (8 hr. average) for more than 30 days per year
(set by OSHA) (Even workers wearing correct personal
protective equipment) |
Evaluate
employee prior to exposure to lead if possible. Workers
contemplating having children may need counseling prior to
beginning job. Blood lead level at least every 2 months for the
first 6 months, then every 6 months, and an annual exam. |
| Worker with a
BLL of > 10 µg/dL |
Report to ADHS |
| Worker with a
BLL of >25 ug/dL |
ADHS provides
educational follow-up with worker. Threshold for health effects in
adults. |
| Worker with a
BLL of >40 ug/dL any time within the last 12 months |
Medical
examination and evaluation for organ toxicity annually. BLL at
least every 2 months until 2 consecutive tests are < 40 ug/dL.
Workers of reproductive age may need special counseling.Industrial
hygeine practices should be evaluated immediately. |
| Worker with BLL
50 - 59 ug/dL or Worker with a medical condition which places the
employee at increased risk of material impairment to health from
exposure to lead. |
May indicate
medical removal from work. Monitor monthly. Consider referral for
toxicology evaluation. OSHA Lead Standard requires removal of
worker from the lead environment when the average of the previous
three blood sampling tests (or the average of all blood lead tests
conducted over the previous six months whichever is longer) is at
or above 50 ug/dL. |
| Worker with BLL
> 60 ug/dL |
Recommend
removal from lead environment. Employee should not return to lead
environment until two consecutive BLL's are < 40 ug/dL. |
| Worker with
symptoms of lead poisoning |
Evaluate
immediately |
| Worker is
pregnant |
Evaluate
immediately |
| Worker with
difficulty breathing while wearing a respirator |
Evaluate
immediately |
Based on: OSHA Lead
Standard: 29 CFR 1910.1025, ADHS
STATUTE: A.R.S. 36-1673 & Medical Toxicologist Consultation
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Treatment Considerations |
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Most cases of lead
poisoning in adults can be managed with removal from the lead source and
supportive care of symptoms. But some patients will benefit from treatment
with a chelating agent. The drug of choice for treatment of lead poisoning
is Succimer, or Chemet®. Second choice is D-Penicillamine. Consultation
with a medical toxicologist is strongly recommended for specific chelation
guidelines. (Please see contact information below). In general, chelation
is considered in the following instances:
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Patient is symptomatic
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Patient has consistently
high blood lead levels
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Patient with elevated
blood lead level who has fertility related concerns, but is not pregnant
Hospitalization is rarely
necessary. Situations requiring hospitalization include:
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Patient with encephalopathy
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Patient with acute respiratory
toxicity
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Patient who has inhaled
fumes from molten lead
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Patient who has massive
acute ingestion of lead
Hospitalized patients
may benefit from parenteral treatment with other chelators. BAL (dimercaprol)
or CaNa2EDTA may be used. Consultation with a medical toxicologist
is strongly recommended.
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Follow-Up Guidelines |
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Follow-up should
be tailored to the individual. Repeated blood lead screening should be
conducted for as long as patient is either exposed or symptomatic. Medical
treatment or industrial hygiene interventions are commonly necessary for
persons with long term exposure. Individuals with occupational exposure
should shower at work to prevent take-home exposure of children.
Follow-up should
include investigation of others exposed at work and household contacts
of exposed individuals, particularly children. Screening should be conducted
according to the Centers for Disease Control and Prevention (CDC) guidelines.
Copies of the guidelines are available at ADHS (see contact information).
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Contacts Information |
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For reporting
and educational follow-up of cases:
Arizona Department of Health Services (602) 364-3118;
Fax (602) 364-3146
For medical toxicology
consultation:
In Tucson: Arizona Poison and Drug Information
Center, Tucson (520) 626-6016
In Phoenix: Samaritan Regional Poison Center,
Phoenix (602) 253-0813
or statewide at (800) 362-0101
For workplace
compliance information:
Arizona Department of Occupational Safety and
Health (602) 542-5795
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