Lead is a widely used but toxic metal that can give rise to life-threatening poisoning and cause long-term negative effects on health. Exposure can result from the ingestion of lead-containing substances or products, from inhalation of fumes during occupational exposure and from exposure to environmental contaminants. Individual cases of lead poisoning continue to occur owing to the many sources described in section 4. In addition, there have been a number of mass lead-poisoning events around the world, mostly related to environmental contamination or contamination of food (1–4). The morbidity and mortality associated with environmental exposures to lead can be very high. In northwest Nigeria in 2010, for example, an estimated 400 children died from environmental lead poisoning and over 1000 children < 5 years of age were treated with chelation therapy in a humanitarian response operation (4).

Lead exposure is a significant public health concern. It is estimated to have accounted for 0.90 million deaths from long-term health effects and 21.7 million disability-adjusted life years in 2019 (5). Children are particularly vulnerable, and WHO has estimated that lead exposure accounts for 30% of the global burden of idiopathic developmental intellectual disability (6).

The most important aspect of the management of lead exposure is identification and removal of the source of exposure. Depending on the circumstances and severity of exposure, other management measures that can be used are GI decontamination to remove material from the GI tract, nutritional supplementation to mitigate the effects of lead poisoning and chelation therapy to facilitate elimination of lead from the body. In many countries, the management of lead exposure is difficult, particularly with regard to access to laboratory services for diagnosis, access to chelating agents for treatment and environmental services for source identification and remediation. Four chelating agents are in common use for lead poisoning: dimercaprol, penicillamine, sodium calcium edetate and succimer; however, these are not available in all countries.

The purpose of this guideline is to assist physicians in making decisions about the diagnosis and treatment of lead exposure for individual patients. The recommendations can be adapted for mass poisoning incidents. The guideline can be used to inform the development of national programmes for the diagnosis and management of lead poisoning. It can also be used by other groups to develop their own treatment protocols.

The guidelines present evidence-informed recommendations on:

• interpretation of blood lead concentrations,
• use of GI decontamination,
• use of nutritional supplementation and
• use of a chelating agent.

The guideline does not include discussion of methods for preventing lead exposure, such as environmental remediation, which will be the subject of a separate guideline document.