CMAJ • January 2, 2007; 176 (1). doi:10.1503/cmaj.060790.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Review

Lead and mercury exposures: interpretation and action

Elizabeth Brodkin, Ray Copes, Andre Mattman, James Kennedy, Rakel Kling and Annalee Yassi

From the Community Medicine Residency Program (Brodkin), the Departments of Health Care and Epidemiology (Copes, Yassi), Medicine (Copes, Kennedy), Pathology (Mattman) and Pharmacology (Kennedy), and the Division of Occupational Medicine (Yassi), Department of Medicine, Faculty of Medicine, University of British Columbia; the BC Centre for Disease Control (Copes); the National Collaborating Centre — Environmental Health (Copes); the School of Occupational and Environmental Hygiene (Copes, Kling), University of British Columbia; the Department of Pathology and Laboratory Medicine (Mattman), Children's & Women's Health Centre of British Columbia; the BC Drug and Poison Information Centre (Kennedy); and the Canada Research Chair in Transdisciplinary and Global Health (Yassi), Vancouver, BC

Correspondence to: Dr. Elizabeth Brodkin, Community Medicine Residency Program, Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, 5804 Fairview Ave., Vancouver BC V6T 1Z3; ebrodkin{at}interchange.ubc.ca

Abstract

Lead and mercury are naturally occurring elements in the earth's crust and are common environmental contaminants. Because people concerned about possible exposures to these elements often seek advice from their physicians, clinicians need to be aware of the signs and symptoms of lead and mercury poisoning, how to investigate a possible exposure and when intervention is necessary. We describe 3 cases of patients who presented to an occupational medicine specialist with concerns of heavy metal toxicity. We use these cases to illustrate some of the issues surrounding the investigation of possible lead and mercury exposures. We review the common sources of exposure, the signs and symptoms of lead and mercury poisoning and the appropriate use of chelation therapy. There is a need for a clear and consistent guide to help clinicians interpret laboratory investigations. We offer such a guide, with information about population norms, lead and mercury levels that suggest exposure beyond that seen in the general population and levels that warrant referral for advice about clinical management.




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