Skip to main content

Lead: Tiny but Mighty Poison


The documentation of lead toxicity (plumbism) dates back to the times when man learnt its various applications. This versatile heavy metal is non-degradable and its ability to get accumulated in the body that goes undiagnosed, makes it a serious environmental health hazard. Lead is now known to affect almost every organ/tissue of the human body. With irreversible effects on neurobiological development of young children and foetus, its toxicity has lasting implications on the human life. Outlining the symptoms, diagnosis and treatment therapy for lead poisoning, the present review elaborates the pathophysiological effects of lead on various organs. This will be of immense help to the health professionals so as to inculcate a better understanding of the lead poisoning which otherwise is asymptomatic. With chelation therapy being the classic path of treatment, new strategies are being explored as additive/adjunct therapy. It is now understood that lead toxicity is completely preventable. In this regard significant efforts are in place in the developed countries whereas much needs to be done in the developing countries. Spreading the awareness amongst the masses by educating them and reducing the usage of lead following stricter industry norms appears to be the only roadmap to prevent lead poisoning. Efforts being undertaken by the Government of India and other organisations are also mentioned.

This is a preview of subscription content, access via your institution.

Fig. 1



Advisory Committee on Childhood Lead Poisoning Prevention


δ-Aminolevulinic acid


δ-Aminolevulinic acid dehydratrase


δ-Aminolevulinic acid synthetase


Blood brain barrier


Blood lead level




Centres for Disease Control and Prevention


Erythrocyte protoporphyrin


Reduced glutathione




Human chorionic gonadotropin


International Agency for Research in Cancer


Intelligence quotient


N-acetyl cysteine


National Referral Centre for Lead Poisoning in India


Red blood cell


Reactive oxygen species


Superoxide dismutase


  1. 1.

    D’souza HS, Dsouza SA, Menezes G, Venkatesh T. Diagnosis, evaluation, and treatment of lead poisoning in general population. Indian J Clin Biochem. 2011;26:197–200.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  2. 2.

    ChemID plus. Lead and lead compounds. Bethesda, MD: U.S. National Library of Medicine; 2005.

    Google Scholar 

  3. 3.

    Wani AL, Ara A, Usmani JA. Lead toxicity: a review. Interdiscip Toxicol. 2015;8:55–64.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Ercal N, Gurer-Orhan H, Aykin-Burns N. Toxic metals and oxidative stress Part. I: mechanisms involved in metal-induced oxidative damage. Curr Top Med Chem. 2001;1:529–39.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Gidlow DA. In-depth review: lead toxicity. Occup Med. 2015;65:348–56.

    CAS  Article  Google Scholar 

  6. 6.

    Chandran L, Cataldo R. Lead poisoning: basics and new developments. Pediatr Rev. 2010;31:399–405.

    PubMed  Article  Google Scholar 

  7. 7.

    Multani A. Lead contamination of drinking water in India due to PVC pipes. LEAD Action News. 2001;10(1):12–5.

    Google Scholar 

  8. 8.

    Kianoush S, Sadeghi M, Balali-Mood M. Recent advances in the clinical management of lead poisoning. Acta Med Iran. 2015;53:327–36.

    PubMed  Google Scholar 

  9. 9.

    Sanborn MD, Abelsohn A, Campbell M, Weir E. Identifying and managing adverse environmental health effects: 3. Lead exposure. CMAJ. 2002;166:1287–92.

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Agency for Toxic Substances and Disease Registry Case Studies in Environmental Medicine (CSEM). Lead Toxicity. Atlanta: US Department of Health and Human Services, Public Health Service; 2010.

    Google Scholar 

  11. 11.

    Why barns are red: the health risks from lead and their prevention. A resource manual to promote public awareness. Metropolitan Toronto Teaching Health Units and the South Riverdale Community Health Centre, Toronto; 1995.

  12. 12.

    Bellinger D, Leviton A, Rubinovitz M, Needleman H, Waternaux C. Longitudinal analysis of prenatal and postnatal lead exposure and early cognitive development. N Engl J Med. 1987;316:1037–43.

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Loghman-Adham M. Renal effects of environmental and occupational lead exposure. Environ Health Perspect. 1997;105:928–38.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Karri SK, Saper RB, Kales SN. Lead encephalopathy due to traditional medicines. Curr Drug Saf. 2008;3:54–9.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Barbosa F Jr, Tanus-Santos JE, Gerlach RF, Parsons PJ. A critical review of biomarkers used for monitoring human exposure to lead: advantages, limitations, and future needs. Environ Health Perspect. 2005;113:1669–74.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  16. 16.

    Patrick L. Lead toxicity Part. II: The role of free radical damage and the use of antioxidants in the pathology and treatment of lead toxicity. Altern Med Rev. 2006;11:114.

    PubMed  Google Scholar 

  17. 17.

    Centers for Disease Control and Prevention/National Center for Environmental Health. Publications List; Nov 25, 2011.

  18. 18.

    Update: blood lead levels-United States, 1991–1994. Morbidity and Mortality Weekly Report. 1997;46:141–6.

  19. 19.

    Advisory committee on childhood lead poisoning prevention (ACCLPP). CDC; 2012.

  20. 20.

    Occupational safety and health guideline for inorganic lead. CDC: U.S. Department of Health and Human Services; 1988.

  21. 21.

    Patocka J. Organic lead toxicology. Acta Med. 2008;51:209–13.

    CAS  Google Scholar 

  22. 22.

    Nevin R. Understanding international crime trends: the legacy of preschool lead exposure. Environ Res. 2007;104:315–36.

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    American Academics of Pediatrics. Lead exposure in children: prevention, detection and management. Pediatrics. 2005;116:1036–46.

    Article  Google Scholar 

  24. 24.

    Wetmur JG. Influence of the common human δ-aminolevulinate dehydratase polymorphism on lead body burden. Environ Health Perspect. 1994;102:215–9.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  25. 25.

    Strayer DS, Rubin E. Environmental and nutritional pathology. In: Rubin R, Strayer DS, editors. Rubins pathology; Clinicopathologic foundations of medicine. 5th ed. Philadelphia: Lippincot; 2008. p. 253–84.

    Google Scholar 

  26. 26.

    Ibrahim NM, Eweis EA, El-Beltagi HS, Abdel- Mobdy YE. Effect of lead acetate toxicity on experimental male albino rat. Asian Pac J Trop Biomed. 2012;2:41–6.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Kosnett MJ. Lead. In: Olson KR, editor. Poisoning and drug overdose. 5th ed. New York: McGraw Hill Professional; 2006.

    Google Scholar 

  28. 28.

    Kosnett MJ, Wedeen RP, Rothenberg SJ, Hipkins KL, Materna BL, Schwartz BS, et al. Recommendations for medical management of adult lead exposure. Environ Health Perspect. 2007;115:463–71.

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Grant LD. Lead and compounds. In: Lippmann M, editor. Environmental toxicants: human exposures and their health effects. 3rd ed. Hoboken, NJ: Wiley; 2008. p. 757–809.

    Google Scholar 

  30. 30.

    Flora SJ. Arsenic-induced oxidative stress and its reversibility. Free Radic Biol Med. 2011;51:257–81.

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Flora SJS. Nutritional components modify metal absorption, toxic response and chelation therapy. J Nutr Environ Med. 2002;12:53–67.

    CAS  Article  Google Scholar 

  32. 32.

    Hultberg B, Andersson A, Isaksson A. Interaction of metals and thiols in cell damage and glutathione distribution: potentiation of mercury toxicity by dithiothreitol. Toxicology. 2001;156:93–100.

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Ahamed M, Siddiqui MKJ. Low level lead exposure and oxidative stress: current opinions. Clin Chim Acta. 2007;383:57–64.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Flora SJ, Saxena G, Mehta A. Reversal of lead-induced neuronal apoptosis by chelation treatment in rats: role of reactive oxygen species and intracellular Ca2+. J Pharmacol Exp Ther. 2007;322:108–16.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Corradi M, Goldoni M, Sabbadini M. Acute lead poisoning: a singular case of haemolytic anemia and lead colic. Med Lav. 2011;102:243–9.

    CAS  PubMed  Google Scholar 

  36. 36.

    Kiziler AR, Aydemir B, Onaran I, Alici B, Ozkara H, Gulyasar T, et al. High levels of cadmium and lead in seminal fluid and blood of smoking men are associated with high oxidative stress and damage in infertile subjects. Biol Trace Elem Res. 2007;120:82–91.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Kasperczyk S, Birkner E, Kasperczyk A, Zalejska-Fiolka J. Activity of superoxide dismutase and catalase in people protractedly exposed to lead compounds. Ann Agric Environ Med. 2004;11:291–6.

    CAS  PubMed  Google Scholar 

  38. 38.

    Oyagbemi AA, Omobowale TO, Akinrinde AS, Saba AB, Ogunpolu BS, Daramola O. Lack of reversal of oxidative damage in renal tissues of lead acetate treated rats. Environ Toxicol. 2015;30:1235–43.

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Vaziri ND, Khan M. Interplay of reactive oxygen species and nitric oxide in the pathogenesis of experimental lead-induced hypertension. Clin Exp Pharmacol Physiol. 2007;34:920–5.

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Roy A, Queirolo E, Peregalli F, Manay N, Martinez G, Kordas K. Association of blood lead levels with urinary F2-8α isoprostane and 8-hydroxy-2-deoxy-guanosine concentrations in first-grade Uruguayan children. Environ Res. 2015;140:127–35.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  41. 41.

    Assi MA, Hezmee MNM, Haron AW, Sabri MYM, Rajion MA. The detrimental effects of lead on human and animal health. Vet World. 2016;9:660–71.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    White LD, Cory-Slechta DA, Gilbert ME, Tiffany-Castiglioni E, Zawia NH, Virgolini M, et al. New and evolving concepts in the neurotoxicology of lead. Toxicol Appl Pharmacol. 2007;225:1–27.

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Baranowska-Bosiacka I, Gutowska I, Rybicka M, Nowacki P, Chlubek D. Neurotoxicity of lead. Hypothetical molecular mechanisms of synaptic function disorders. Neurol Neurochir Pol J. 2012;46:569–78.

    CAS  Google Scholar 

  44. 44.

    Vij AG, Dhundasi SA. Hemopoietic, hemostatic and mutagenic effects of lead and possible prevention by zinc and vitamin C. Al Ameen J Med Sci. 2009;2:27–36.

    CAS  Google Scholar 

  45. 45.

    Ahamed M, Verma S, Kumar A, Siddiqui MKJ. Environmental exposure to lead and its correlation with biochemical indices in children. Sci Total Environ. 2005;46:48–55.

    Article  CAS  Google Scholar 

  46. 46.

    Cleveland LM, Minter ML, Cobb KA, Scott AA, German VF. Lead hazards for pregnant women and children. Am J Nurs. 2008;108:40–9.

    Google Scholar 

  47. 47.

    Fujita H, Nishitani C, Ogawa K. Lead, chemical porphyria, and heme as a biological mediator. Tohoku J Exp Med. 2002;196:53–64.

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Casaret LJ, Klaassen CD, Doull J, editors. Toxic effects of metals. Casarett and Doull’s toxicology: the basic science of poisons. 7th ed. New York: McGraw Hill Professional; 2007.

    Google Scholar 

  49. 49.

    Garza A, Vega R, Soto E. Cellular mechanisms of lead neurotoxicity. Med Sci Monit. 2006;12:RA57–65.

    PubMed  Google Scholar 

  50. 50.

    Lidsky TI, Schneider JS. Lead neurotoxicity in children: basic mechanisms and clinical correlates. Brain. 2003;126:5–19.

    PubMed  Article  Google Scholar 

  51. 51.

    Bressler J, Kim KA, Chakraborti T, Goldstein G. Molecular mechanisms of lead neurotoxicity. Neurochem Res. 1999;24:595–600.

    CAS  PubMed  Article  Google Scholar 

  52. 52.

    Kosnett MJ. Lead. In: Brent J, editor. Critical care toxicology: diagnosis and management of the critically poisoned patient. Houston: Gulf Professional Publishing; 2005. p. 822.

    Google Scholar 

  53. 53.

    Brent JA. Review of medical toxicology. J Clin Toxicol. 2006;44:355.

    Article  Google Scholar 

  54. 54.

    Mtui E, Gruener G, FitzGerald MJT. Clinical neuroanatomy and neuroscience. Philadelphia, PA: Elsevier Health Sciences; 2011.

    Google Scholar 

  55. 55.

    Sanders T, Liu Y, Buchner V, Tchounwou PB. Neurotoxic effects and biomarkers of lead exposure: a review. Rev Environ Health. 2009;24:15–46.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  56. 56.

    Pearson HA, Schonfeld DJ. Lead. In: Rudolph CD, editor. Rudolph’s pediatrics. 21st ed. New York: McGraw-Hill Professional; 2003. p. 1016–56.

    Google Scholar 

  57. 57.

    Park SK, O’Neill MS, Vokonas PS, Sparrow D, Wright RO, Coull B, et al. Air pollution and heart rate variability: effect modification by chronic lead exposure. Epidemiology. 2008;19:111–20.

    PubMed  PubMed Central  Article  Google Scholar 

  58. 58.

    Bellinger DC. Very low lead exposures and children’s neurodevelopment. Curr Opin Pediatr. 2008;20:172–7.

    PubMed  Article  Google Scholar 

  59. 59.

    Brunton LL, Goodman LS, Blumenthal D, Buxton I, Parker KL, editors. Goodman and Gillmans manual of pharmocology and theraupetics. New York: McGraw Hill Professional; 2007.

    Google Scholar 

  60. 60.

    Winneke G, Brockhaus A, Ewers U, Kramer U, Neuf M. Results from the European multicenter study on lead neurotoxicity in children: implications for risk assessment. Neurotoxicol Teratol. 1990;12:553–9.

    CAS  PubMed  Article  Google Scholar 

  61. 61.

    International Programme on Chemical Safety (IPCS). Evaluation—monograph on lead, inorganic. Geneva: World Health Organization; 2007.

    Google Scholar 

  62. 62.

    National Poisons Information Service (NPIS) US. Lead. TOXBASE, Health Protection Agency; 2010.

  63. 63.

    Billings RJ, Berkowitz RJ, Watson G. Teeth. Pediatrics. 2004;113:1120–7.

    PubMed  Google Scholar 

  64. 64.

    Triebig G, Weltle D, Valentin H. Investigations on neurotoxicity of chemical substances at the workplace. V. Determination of the motor and sensory nerve conduction velocity in persons occupationally exposed to lead. Int Arch Occup Environ Health. 1984;53:189–203.

    CAS  PubMed  Article  Google Scholar 

  65. 65.

    Davis JM, Svendsgaard DJ. Nerve conduction velocity and lead: a critical review and meta-analysis. In: Johnson BL, Anger WK, Durao A, Xinteras C, editors. Advances in neurobehavioural toxicology: applications in environmental and occupational health. Chelsea, MI: Michigan Lewis Publishers; 1990. p. 353–76.

    Google Scholar 

  66. 66.

    Stollery BT, Banks HA, Broadbent DE, Lee WR. Cognitive functioning in lead workers. Br J Ind Med. 1989;46:698–707.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. 67.

    Hanninen H, Aitio A, Kovala T, Luukkonen R, Matikainen E, Mannelin T, et al. Occupational exposure to lead and neuropsychological dysfunction. Occup Environ Med. 1998;55:202–9.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  68. 68.

    Baker EL, White RF, Pothier LJ, Berkey CS, Dinse GE, Travers PH, et al. Occupational lead neurotoxicity: improvement in behavioural effects after reduction of exposure. Br J Ind Med. 1985;42:507–16.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. 69.

    Renner R. Exposure on tap: drinking water as an overlooked source of lead. Environ Health Perspect. 2010;118:A68–72.

    PubMed  PubMed Central  Article  Google Scholar 

  70. 70.

    Schoeters G, Hond ED, Dhooge W, Larebeke NV, Leijs M. Endocrine disruptors and abnormalities of pubertal development. Basic Clin Pharmacol & Toxicol. 2008;102:168–75.

    CAS  Article  Google Scholar 

  71. 71.

    Borja-Aburto VH, Hertz-Picciotto I, Rojas Lopez M, Farias P, Rios C, Blanco J. Blood lead levels measured prospectively and risk of spontaneous abortion. Am J Epidemiol. 1999;150:590–7.

    CAS  PubMed  Article  Google Scholar 

  72. 72.

    Zhang H, Liu Y, Zhang R, Liu R, Chen Y. Binding mode investigations on the interaction of lead (II) Acetate with human chorionic gonadotropin. J Phys Chem B. 2014;118:9644–50.

    CAS  PubMed  Article  Google Scholar 

  73. 73.

    Health Protection Agency. Lead toxicological overview. Version 3. London: H.P.A; 2012.

    Google Scholar 

  74. 74.

    Hu H. Knowledge of diagnosis and reproductive history among survivors of childhood plumbism. Am J Public Health. 1991;81:1070–2.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  75. 75.

    Saleh HA, El-Aziz GA, El-Fark MM, El-Gohary M. Effect of maternal lead exposure on craniofacial ossification in rat fetuses and the role of antioxidant therapy. Anat Histol Embryol. 2009;38:392–9.

    CAS  PubMed  Article  Google Scholar 

  76. 76.

    Wadi S, Ahmad G. Effects of lead on the male reproductive system in mice. J Toxicol Environ Health A. 1999;56:513–21.

    CAS  PubMed  Article  Google Scholar 

  77. 77.

    Telisman S, Cvitkovic P, Jurasovic J, Pizent A, Gavella M, Rocic B. Semen quality and reproductive endocrine function in relation to biomarkers of lead, cadmium, zinc, and copper in men. Environ Health Perspect. 2000;108:45.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  78. 78.

    Navas-Acien A, Guallar E, Silbergeld EK, Rothenberg SJ. Lead exposure and cardiovascular disease-a systematic review. Environ Health Perspect. 2007;115:472–82.

    CAS  PubMed  Article  Google Scholar 

  79. 79.

    Yu CC, Lin JL, Lin-Tan DT. Environmental exposure to lead and progression of chronic renal diseases: a four-year prospective longitudinal study. J Am Soc Nephrol. 2004;15:1016–22.

    CAS  PubMed  Article  Google Scholar 

  80. 80.

    Carmignani M, Volpe AR, Boscolo P, Qiao N, DiGioacchino M, Grilli A, et al. Catcholamine and nitric oxide systems as targets of chronic lead exposure in inducing selective functional impairment. Life Sci J. 2000;68:401–15.

    CAS  Article  Google Scholar 

  81. 81.

    Finley J. Compositions and methods for the prevention and treatment of diseases or conditions associated with oxidative stress, inflammation, and metabolic dysregulation. U. S. Patent No.8, 652, 518.U. S. Patent and Trademark Office, Washington, DC; 2014.

  82. 82.

    Nisar MF, Nasir I, Shaheen S, Khalid A, Tazeen N. Chronic lead acetate nephrotoxicity: a histological study on albino rats. Ann King Edw Med Univ. 2014;17:239.

    Google Scholar 

  83. 83.

    Gerhardsson L, Chettle DR, Englyst V, Nordberg GF, Nyhlin H, Scott MC, et al. Kidney effects in long term exposed lead smelter workers. Br J Ind Med. 1992;49:186–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  84. 84.

    Ehrlich R, Robins T, Jordaan E, Miller S, Mbuli S, Selby P, et al. Lead absorption and renal dysfunction in a South African battery factory. Occup Environ Med. 1998;55:453–60.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  85. 85.

    Staessen JA, Lauwerys RR, Buchet JP, Bulpitt CJ, Rondia D, Vanrenterghem Y, et al. Impairment of renal function with increasing blood lead concentrations in the general population. N Engl J Med. 1992;327:151–6.

    CAS  PubMed  Article  Google Scholar 

  86. 86.

    Tsaih SW, Korrick S, Schwartz J, Amarasiriwardena C, Aro A, Sparrow D, et al. Lead, diabetes, hypertension, and renal function: the normative aging study. Environ Health Perspect. 2004;112:1178–82.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  87. 87.

    Needleman H. Lead poisoning. Annu Rev Med. 2004;55:209–22.

    CAS  PubMed  Article  Google Scholar 

  88. 88.

    Glenn BS, Stewart WF, Schwartz BS, Bressler J. Relation of alleles of the sodium potassium adenosine triphosphatase alpha 2 gene with blood pressure and lead exposure. Am J Epidemiol. 2001;153:537–45.

    CAS  PubMed  Article  Google Scholar 

  89. 89.

    Cheng Y, Schwartz J, Sparrow D, Aro A, Weiss ST, Hu H. Bone lead and blood lead levels in relation to baseline blood pressure and the prospective development of hypertension: the normative aging study. Am J Epidemiol. 2001;153:164–71.

    CAS  PubMed  Article  Google Scholar 

  90. 90.

    Vupputuri S, He J, Muntner P, Bazzano LA, Whelton PK, Batuman V. Blood lead level is associated with elevated blood pressure in blacks. Hypertension. 2003;41:463–8.

    CAS  PubMed  Article  Google Scholar 

  91. 91.

    Statement on the 2006 UK Total Diet Study of Metals and Other Elements. Committee on Toxicity of Chemicals in Food Consumer Products and the Environment (COT). London: Food Standards Agency; 2008.

  92. 92.

    International Agency for the Research on Cancer (IARC). Inorganic and organic lead compounds. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol. 87. Lyon, France; 2006.

  93. 93.

    Fayerweather WE, Karns ME, Nuwayhid IA, Nelson TJ. Case-control study of cancer risk in tetraethyl lead manufacturing. Am J Ind Med. 1997;3:28–35.

    Article  Google Scholar 

  94. 94.

    National Toxicity Program. Department of Health and Human Carcinogens. 12th ed. Department of Health and Human Services US; 2011.

  95. 95.

    Lundstrom NG, Nordberg G, Englyst V, Gerhardsson L, Hagmar L, Jin T, et al. Cumulative lead exposure in relation to mortality and lung cancer morbidity in a cohort of primary smelter workers. Scand J Work Environ Health. 1997;23:24–30.

    CAS  PubMed  Article  Google Scholar 

  96. 96.

    Wynant W, Siemiatycki J, Parent ME, Rousseau MC. Occupational exposure to lead and lung cancer: results from two case-control studies in Montreal, Canada. Occup Environ Med. 2013;70:164–70.

    PubMed  Article  Google Scholar 

  97. 97.

    Wetmur JG, Kaya AH, Plewinska M, Desnick RJ. Molecular characterization of the human -aminolevulinatedehydratase 2 (ALAD2) allele: implications for molecular screening of individuals for genetic susceptibility to lead poisoning. Am J Hum Genet. 1991;49:757–63.

    CAS  PubMed  PubMed Central  Google Scholar 

  98. 98.

    Schwartz BS, Lee BK, Stewart W, Ahn KD, Springer K, Kelsey K. Associations of δ-aminolevulinic acid dehydratase genotype with plant, exposure duration, and blood lead and zinc protoporphyrin levels in Korean lead workers. Am J Epidemiol. 1995;142:738–45.

    CAS  PubMed  Article  Google Scholar 

  99. 99.

    Agency for Toxic Substances and Disease Registry. Interaction profile for chlorpyrifos, lead, mercury, and methyl mercury. Atlanta, GA: United State Department of Health and Human Services; 2006.

    Google Scholar 

  100. 100.

    Jain NB, Laden F, Guller U, Shankar A, Kazani S, Garshick E. Relation between blood lead levels and childhood anemia in India. Am J Epidemiol. 2005;161:968–73.

    PubMed  Article  Google Scholar 

  101. 101.

    Schwartz BS, Lee BK, Lee GS, Stewart WF, Simon D, Kelsey K, et al. Associations of blood lead, dimercaptosuccinic acid chelatable lead, and tibia lead with polymorphisms in the vitamin D receptor and [delta] aminolevulinic acid dehydratase genes. Environ Health Perspect. 2000;108:949–54.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  102. 102.

    Piomelli S. Childhood lead poisoning. Pediatr Clin North Am J. 2002;49:1285–304.

    Article  Google Scholar 

  103. 103.

    Kumar A, Prasad MNV, Achary VMM, Panda BB. Elucidation of lead-induced oxidative stress in Talinumtriangulare roots by analysis of antioxidant responses and DNA damage at cellular level. Environ Sci Pollut Res. 2013;20:4551–61.

    CAS  Article  Google Scholar 

  104. 104.

    Flora SJS, Pachauri V. Chelation in metal intoxication. Int J Environ Res Public Health. 2010;7:2745–88.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  105. 105.

    Wang C, Liang J, Zhang C, Bi Y, Shi X, Shi Q. Effect of ascorbic acid and thiamine supplementation at different concentrations on lead toxicity in liver. Ann Occup Hyg. 2007;51:563–9.

    CAS  PubMed  Google Scholar 

  106. 106.

    Kim JS, Hamilton DL, Blakley BR, Roussraux CG. The effects of thiamine on lead metabolism: organ distribution of lead. Can J Vet Res. 1992;56:256–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  107. 107.

    Najarnezhad V, Aslani MR, Balali-Mood M. The therapeutic potential of thiamine for treatment of experimentally induced sub-acute lead poisoning in sheep. Comp Clin Patol. 2010;19:69–73.

    CAS  Article  Google Scholar 

  108. 108.

    Sajitha GR, Jose R, Andrews A, Ajantha KG, Augustine P, Augusti KT, et al. Garlic oil and vitamin E prevent the adverse effects of lead acetate and ethanol separately as well as in combination in the drinking water of rats. Indian J Clin Biochem. 2010;25:280–8.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  109. 109.

    Caylak E, Aytekin M, Halifeoglu I. Antioxidant effects of methionine, alpha-lipoic acid, N-acetylcysteine and homocysteine on lead-induced oxidative stress to erythrocytes in rats. Exp Toxicol Pathol. 2008;60:289–94.

    CAS  PubMed  Article  Google Scholar 

  110. 110.

    Chen W, Ercal N, Huynh T, Volkov A, Chusuei CC. Characterizing N-acetylcysteine (NAC) and N-acetylcysteine amide (NACA) binding for lead poisoning treatment. J Colloid Interface Sci. 2012;371:144–9.

    CAS  PubMed  Article  Google Scholar 

  111. 111.

    Flora SJ, Pande M, Bhadauria S, Kannan GM. Combined administration of taurine and meso 2, 3 dimercaptosuccinic acid in the treatment of chronic lead intoxication in rats. Hum Exp Toxicol. 2004;23:157–66.

    CAS  PubMed  Article  Google Scholar 

  112. 112.

    Kianoush S, Balali-Mood M, Mousavi SR, Moradi V, Sadeghi M, Dadpour B, et al. Comparison of therapeutic effects of garlic and d-Penicillamine in patients with chronic occupational lead poisoning. Basic Clin Pharmacol Toxicol. 2012;110:476–81.

    CAS  PubMed  Article  Google Scholar 

  113. 113.

    Deldar K, Nazemi E, Balali MM, Emami SA, MohammadPour AH, Tafaghodi M, et al. Effect of Coriandrum sativum L. extract on lead excretion in 3-7 year old children. J Birjand Univ Med Sci. 2008;15:11–9.

    Google Scholar 

  114. 114.

    Venkatesh T. Lead is hampering the Quality of our lives. In: Gyani GJ, editor. Quality India, vol. 2. 2008. p. 22–3.

    Google Scholar 

  115. 115.

    van Alphen M. Lead poisoning in India. LEAD Action News 1999;7(1):2–3.

  116. 116.

    Singh AK, Singh M. Lead decline in the Indian environment resulting from the petrol-lead phase-out programme. Sci Total Environ. 2006;368:686–94.

    CAS  PubMed  Article  Google Scholar 

  117. 117.

    Maya C. Lead poisoning: warning bells toll. The Hindu. Updated on Aug 22, 2011.

  118. 118.

    Mitra P. Lead poisoning affects 20% Kolkata kids. Times of India; Jul 14, 2013.

  119. 119.

    Regulation on Lead contents in Household and Decorative Paints Rules, 2016. The Gazzette of India, Ministry of Environment, Forest and Climate Change notification, New Delhi; Nov 1, 2016.

  120. 120.

    Chatterjee P. Explained: the controversy surrounding Maggi Noodles. Indian Express Updated on Jun 5, 2015.

  121. 121.

    After Maggi and Knorr, Top Ramen noodles withdrawn from market. Hindustan times Updated on Jun 30, 2015.

  122. 122.

    New stocks of Maggi noodles cleared by labs, likely to hit stores this month: Nestle. Indian Express. Updated on Nov 4, 2015.

  123. 123.

    Lane RE. The care of the lead worker. Br J Ind Med. 1949;6:125–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  124. 124.

    Chey H, Buchanan S. Toxins in everyday life. Prim Care. 2008;35:707–27.

    PubMed  Article  Google Scholar 

  125. 125.

    Warniment C, Tsang K, Galazka SS. Lead poisoning in children. Am Fam Physician. 2010;81:751–7.

    PubMed  Google Scholar 

  126. 126.

    Woolf AD, Goldman R, Bellinger DC. Update on the clinical management of childhood lead poisoning. Pediatr Clin North Am. 2007;54:271–94.

    PubMed  Article  Google Scholar 

  127. 127.

    Levin R, Brown MJ, Kashtock ME, Jacobs E, Whelan EA, Rodman J, et al. Lead exposures in U.S. Children, 2008: implications for prevention. Environ Health Perspect. 2008;2008(116):1285–93.

    Article  CAS  Google Scholar 

  128. 128.

    Shaik AP, Sultana SA, Alsaeed AH. Lead exposure: a summary of global studies and the need for new studies from Saudi Arabia. Dis Markers. 2014;2014:415160–6.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

Download references

Author information




KKS conceptualized the idea of the review, guided through it, critically read and organized the final manuscript. CS, KT and AS researched the data and drafted the manuscript.

Corresponding author

Correspondence to Krishan Kumar Sharma.

Ethics declarations

Conflict of interest

The authors have no conflict of interest with this manuscript.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sachdeva, C., Thakur, K., Sharma, A. et al. Lead: Tiny but Mighty Poison. Ind J Clin Biochem 33, 132–146 (2018).

Download citation


  • BLL
  • Chelation therapy
  • Lead poisoning
  • Pathophysiology
  • Prevention