lead is a soft , pliable , bluish - grey metal resistant to corrosion , that exists in both organic and inorganic forms . this metal does not conduct electricity and it owns antiradiation properties . lead poisoning in children is an important health problem , accounting for 0.6% of the global burden of the disease according to the world health organization . according to the national health and nutrition examination survey data , from 2007 to 2010 , approximately 535,000 children aged 1 to 5 years , meaning 2.6% , presented blood lead level above 5  g / dl . even though lead is everywhere the ways of contamination include ingestion , inhalation , prenatal exposure , and dermal exposure , but the most important and frequent ones are ingestion and inhalation . the half - life of lead is between 30 and 40 days in men , while in children and pregnant women it can be longer . it binds to the sulfhydryl group of proteins leading to toxicity for multiple enzyme systems . the clinical presentation of lead poisoning involves nervous , hematologic , and renal systems impairment , but it can also lead to gastrointestinal disorders ( anorexia , vomiting , constipation , abdominal pain ) , hypertension , and fertility impairment . neurological symptoms include ataxia , stupor , coma , convulsions , hyperirritability , reduced iq , shortened attention span , increased antisocial behavior , reduced educational attainment , and even death . impairment of the hematological system may involve either disruption of heme synthesis or hemolysis , leading to anemia with its specific clinical signs , like weakness and fatigue . the effects of lead on the renal system consist in proximal tubular function impairment leading to aminoaciduria , glycosuria , and hyperphosphaturia , interstitial nephritis in chronic exposure , and also impairment of calcium metabolism by interfering with activation of vitamin d 1,2-dihydroxy cholecalciferol . the diagnosis is established on the blood lead level , higher than 40  g / dl for occupational and 30  g / dl for nonoccupational exposure . primary and secondary preventions should be the first steps in the management of lead poisoning as public health problem . if a patient is found with high blood lead level , the test must be repeated before considering any therapy . chelating agents are recommended only if the level is above 45  g / dl , and the type will be chosen according to the blood level and symptoms . the available agents nowadays include : 2,3 dimercaptosuccinic acid ( dmsa ) , dimercaprol , ethylene diamine tetra - acetic acid ( cana2edta ) , d - penicillamine . in certain cases , the management can also include supportive therapy , like airway protection in acute encephalopathy or antiepileptic drugs in case of seizures . we present a case report of lead poisoning in a 16-year - old girl with the aim of highlighting the difficulty in diagnosing this condition , and the fact that even though occupational exposure is the main cause of lead poisoning in adults by inhalation , it can also be present in children in certain circumstances , as in our case . the informed consent was given by the patient 's father ( legal guardian ) for publication of this case report . we present the case of a 16-year - old girl , admitted to our clinic with severe abdominal pain , loss of appetite , nausea , and vomiting . the anamnesis revealed that the girl comes from a family of potters , and that she also participated in the process of pottery , her father being diagnosed with lead poisoning 2 years before . the patient 's personal history underlined that approximately 1 year ago she presented with severe abdominal pain , being diagnosed with acute appendicitis and she underwent appendectomy , but the pain persisted , thus due to family history of lead poisoning , the suspicion of saturnine colic rose , and she was diagnosed with lead poisoning ( urinary lead : 219  g / l ) , but she received only symptomatic treatment . approximately 3 weeks before admission to our clinic , she was admitted to the regional hospital with another episode of saturnine colic ( blood lead : 113.2  g / dl ) , and chelation therapy with edta ( 4 days before the admission in our clinic ) was initiated , with a dose of 2 tablets daily , one in the morning and one in the evening associated with calcium supplements . the clinical examination performed at the time of admission revealed the following pathological elements : influenced general status , ailing face , jaundice of the sclera , blue pigmentation of the nails , painful abdomen at palpation , and weight : 45  kg . the laboratory test performed upon admission revealed hypochromic anemia ( hemoglobin ( hb ) : 10.9  g / dl , hematocrit ( htc ) : 31.6% , medium cellular volume ( mcv ) : 77.6 fl ) , increased level of liver transaminases ( alanine - aminotransferase ( alat ) : 158.9  u / l , aspartate - aminotransferase ( asat ) : 63  u / l , gamma - glutamyl - transferase ( ggt ) : 128  u / l ) , conjugated hyperbilirubinemia ( direct bilirubin ( dbi ) : 1.432  mg / dl ) , hyponatremia ( na : 132 mmol / l ) , and hypopotassemia ( k : 2.85  mmol / l ) . the systolic arterial pressure was 156 mm hg , and the diastolic was 96 mm hg . the blood lead level was 66.28  g / dl , the urinary one was 419.7  g / l ( normal < 50  g / l ) and the value of delta - aminolevulinic acid was 7.66  mg / l ( normal we also performed abdominal ultrasound which revealed a disappearance of the delimitation between the cortical and medullar parts in both kidneys . we requested consultation from an occupational healthcare specialist , who recommended the continuation of chelation therapy with edta , increasing the dose at 4  tablets / day . we also required a neurological consultation , and the specialist established the diagnosis of behavioral disorders with depressive elements , and recommended psychotherapy . based on all these clinical and laboratory findings , we established the diagnosis of lead poisoning . hydration in order to favor lead elimination , approximately 3 liters per 24  hours initially , and we decreased progressively the quantity once she ceased to vomit , and she was able to consume liquids . we associated diuretics , initially furosemide by vein , but the values of the arterial pressure persisted above the upper limit , therefore we were forced to introduce also an angiotensin - converting enzyme inhibitor , with the remission of arterial hypertension . regarding the liver function , we administered amino acids intravenously , associated with liver protectors by mouth . we also administered vitamins of the b complex in order to improve the neurological impairment . the evolution was slightly favorable , in the first 3 days after the admission , the patient continued to present severe abdominal pain , vomiting , and she also complained of pain in the lumbar area . all the laboratory parameters presented normalization of the values after approximately 10 days of treatment . on the 6th day of admission the blood level was 45.57  g / dl , and the urinary one was 836.4 after 14 days of admission , the patient was discharged without any complaints , and we recommended no further exposure to lead , avoiding the contact and the working in the pottery process . the long - term outcome of this case depends on further exposure to this heavy metal . nevertheless , we intend to repeat the blood lead levels after 12 and 24 months , assessing also the renal ( urea , creatinine , urinary exam ) and hepatic functions ( asat , alat , ggt , bilirubin ) . we present the case of a 16-year - old girl , admitted to our clinic with severe abdominal pain , loss of appetite , nausea , and vomiting . the anamnesis revealed that the girl comes from a family of potters , and that she also participated in the process of pottery , her father being diagnosed with lead poisoning 2 years before . the patient 's personal history underlined that approximately 1 year ago she presented with severe abdominal pain , being diagnosed with acute appendicitis and she underwent appendectomy , but the pain persisted , thus due to family history of lead poisoning , the suspicion of saturnine colic rose , and she was diagnosed with lead poisoning ( urinary lead : 219  g / l ) , but she received only symptomatic treatment . approximately 3 weeks before admission to our clinic , she was admitted to the regional hospital with another episode of saturnine colic ( blood lead : 113.2  g / dl ) , and chelation therapy with edta ( 4 days before the admission in our clinic ) was initiated , with a dose of 2 tablets daily , one in the morning and one in the evening associated with calcium supplements . the clinical examination performed at the time of admission revealed the following pathological elements : influenced general status , ailing face , jaundice of the sclera , blue pigmentation of the nails , painful abdomen at palpation , and weight : 45  kg . the laboratory test performed upon admission revealed hypochromic anemia ( hemoglobin ( hb ) : 10.9  g / dl , hematocrit ( htc ) : 31.6% , medium cellular volume ( mcv ) : 77.6 fl ) , increased level of liver transaminases ( alanine - aminotransferase ( alat ) : 158.9  u / l , aspartate - aminotransferase ( asat ) : 63  u / l , gamma - glutamyl - transferase ( ggt ) : 128  u / l ) , conjugated hyperbilirubinemia ( direct bilirubin ( dbi ) : 1.432  mg / dl ) , hyponatremia ( na : 132  mmol / l ) , and hypopotassemia ( k : 2.85  mmol / l ) . the systolic arterial pressure was 156 mm hg , and the diastolic was 96 mm hg . the blood lead level was 66.28  g / dl , the urinary one was 419.7  g / l ( normal < 50  g / l ) and the value of delta - aminolevulinic acid was 7.66  mg / we also performed abdominal ultrasound which revealed a disappearance of the delimitation between the cortical and medullar parts in both kidneys . we requested consultation from an occupational healthcare specialist , who recommended the continuation of chelation therapy with edta , increasing the dose at 4  tablets / day . we also required a neurological consultation , and the specialist established the diagnosis of behavioral disorders with depressive elements , and recommended psychotherapy . based on all these clinical and laboratory findings , we established the diagnosis of lead poisoning . hydration in order to favor lead elimination , approximately 3 liters per 24  hours initially , and we decreased progressively the quantity once she ceased to vomit , and she was able to consume liquids . we associated diuretics , initially furosemide by vein , but the values of the arterial pressure persisted above the upper limit , therefore we were forced to introduce also an angiotensin - converting enzyme inhibitor , with the remission of arterial hypertension . regarding the liver function , we administered amino acids intravenously , associated with liver protectors by mouth . we also administered vitamins of the b complex in order to improve the neurological impairment . the evolution was slightly favorable , in the first 3 days after the admission , the patient continued to present severe abdominal pain , vomiting , and she also complained of pain in the lumbar area . all the laboratory parameters presented normalization of the values after approximately 10 days of treatment . on the 6th day of admission the blood level was 45.57  g / dl , and the urinary one was 836.4 after 14 days of admission , the patient was discharged without any complaints , and we recommended no further exposure to lead , avoiding the contact and the working in the pottery process . the long - term outcome of this case depends on further exposure to this heavy metal . nevertheless , we intend to repeat the blood lead levels after 12 and 24 months , assessing also the renal ( urea , creatinine , urinary exam ) and hepatic functions ( asat , alat , ggt , bilirubin ) . lead poisoning is a severe condition with potential multiorgan damage and even death if lead is present in large amounts in the blood , representing a major health problem . in children , there is no safe lead level , although according to the world health organization , this problem represents approximately 0.6% of the global burden of disease . the former is more common in children due to their tendency of chewing everything , while the latter is more frequent in occupationally exposed adults . in the case presented here , lead entered the blood by inhalation as occupational risk due to the fact that our teenager patient had helped her parents in the pottery process . other occupations with an increased risk for lead toxicity can be battery manufacturing and recycling plants , demolition , remodeling , and renovation projects , rubber and plastic industries , ammunition and manufacturing , automotive/ radiator repair , lead soldering and welding , painting , plumbing , and so on . there are certain storages of lead in the organism , such as bones , teeth , hair , and nails , where it is bound tightly and it does not seem to be harmful since it is not available to other tissues . however in children , only 70% of the absorbed lead will end up in the bones , in comparison with adults in whom 94% will deposit there , fact that can be responsible for the more expressed clinical effects of this condition in small ages . according to lamas and collaborators , it seems that the deposit of active metals , like cadmium and lead , represents a major risk factor for cardiovascular disease . therefore , chelation therapy with edetate disodium can provide important benefits for those with atherosclerotic cardiovascular disorders . it seems that this metal is also incriminated for reducing the bioavailability of nitric oxide , and therefore promoting oxidative stress and inflammation . a recent study assessed the relationship between blood lead levels and childhood asthma , 2 conditions frequently encountered in small children , both related to environmental factors . the study concluded that even though blood lead levels are not significantly associated with asthma diagnosis , the elevated blood levels of this metal lead to a more severe form of asthma in children , being related to eosinophilia and elevated immunoglobulin e levels . the toxicity of blood lead levels on the nervous system is a major concern for children 's normal development . according to the data of the agency for toxic substances and disease registry ( atsdr ) , blood lead level in children , it seems that a blood lead level of 70 to 80  g / dl or greater represents a serious risk . the neurological sequelae of lead poisoning include reduced iq , shortened attention span , increased antisocial behavior , and reduced educational attainment . it was proved that an average increase of blood lead level of 10  g / dl in children will lead to an iq decline between 1.9 to 3.2 points . other sequelae of chronic lead exposure consist in interstitial nephritis , reduction of sperm concentration , total sperm counts , and total sperm motility . on a study performed on 769 american adolescents , fadrowski found that decreased kidney function is positively correlated to a blood lead level less than 10  g / dl , therefore the us government recommends repeated blood lead level testing at 12 and 24 months . we also intend to repeat the blood lead level in our patient at 12 and 24 months . a study performed in developing countries showed that in many latin american countries , lead - glazed ceramics represent a major source of exposure for those who live there . even though the most common cause of lead poisoning in adults is represented by occupational exposure , in our case we detected elevated blood lead levels in a teenage girl after occupational exposure due to the fact that the patient supported the family pottery business . the pottery - making process involves ceramic glazes and decorative paints , which both contain lead . therefore , these hand - made traditional products can represent a real danger not only for potters , but also for those using these products . the diagnosis establishment of this condition can represent a challenge for every physician , especially for a pediatrician due to the fact that the initial symptoms are nonspecific , such as abdominal pain , anorexia , or irritability , suggesting a gastrointestinal pathology . prevention of lead exposure is the most important step in lead poisoning management due to the fact that the neurocognitive damages induced by lead toxicity are irreversible , and also because in children , this metal is much more easily stored than in adults and it impairs the function of multiple organs , such as kidneys , bones , blood , and the brain . for example , in the united states , in 1988 , control disease center ( cdc ) childhood lead poisoning prevention program was created which provided local governments lead poisoning programs . these programs include public health education , policy development , screening protocols , and case management guidelines . we think that it would be of great importance for the potters to benefit at least from public health education about lead toxicity and screening programs for lead poisoning . the screening for lead poisoning would be an important diagnostic tool for the family members involved in the pottery process , diminishing the rate of unreported cases , and also due to the cluster occurrence of this condition . due to the multiple system involvement therefore , the patient submitted to chelation therapy must be closely monitored , because even the elimination of this heavy metal itself can impair the renal function . even though lead is a toxic metal that is easily stored in the body , its removal being almost impossible , chelation therapy remains the standard treatment of lead poisoning . lead toxicity is a life - threatening condition because of its severe acute and chronic complications . in children , there is no safe blood lead level , prevention methods are , therefore , very important in order to avoid toxic multiorganic effects of this metal . even though the diagnosis represents a challenge in case of children mostly due to its rare incidence in teenagers , a physician must always include this possibility in the differential diagnosis for cases with suggestive symptoms .