Introduction — This topic includes links to society and government-sponsored guidelines from selected countries and regions around the world. We will update these links periodically; newer versions of some guidelines may be available on each society's website. Some societies may require users to log in to access their guidelines.
The recommendations in the following guidelines may vary from those that appear in UpToDate topic reviews. Readers who are looking for UpToDate topic reviews should use the UpToDate search box to find the relevant content.
Links to related guidelines are provided separately. (See "Society guideline links: Occupational asthma".)
International
●World Health Organization (WHO): Guidelines for drinking-water quality, 4th edition, incorporating the 1st addendum (2017)
●WHO: Childhood lead poisoning (2010)
Canada
●Health Canada: Guidelines for Canadian drinking water quality – Guideline technical document: Cadmium (2020)
●Canadian Paediatric Society (CPS): Practice point on lead toxicity with a new focus – Addressing low-level lead exposure in Canadian children (2019)
●Choosing Wisely Canada: Don't order blood mercury levels unless dietary history suggests risk, the patient is pregnant or planning to become pregnant, and/or the patient is occupationally exposed to organomercury compounds (updated 2019)
●Health Canada: Guidelines for Canadian drinking water quality – Guideline technical document: Lead (2019)
●Health Canada: Guidelines for Canadian drinking water quality – Guideline technical document: Chromium (2016)
●Health Canada: Final human health state of the science report on lead (2013)
●Health Canada: Guidelines for Canadian drinking water quality − Guideline technical document: Arsenic (2006)
United States
●Centers for Disease Control and Prevention (CDC): Lead − Training and medical guidelines
●American Academy of Pediatrics (AAP): Policy statement on the prevention of childhood lead toxicity (2016, reaffirmed 2021)
●CDC: Recommended actions based on blood lead level – Summary of recommendations for follow-up and case management of children based on initial screening capillary and confirmed* venous blood lead levels (2021)
●Pediatric Environmental Health Specialty Units (PEHSU) and AAP: Recommendations on management of childhood lead exposure – A resource for health professionals (2021)
●CDC: Guidelines on screening for lead during the domestic medical examination for newly arrived refugees (reviewed 2020)
●US Preventive Services Task Force (USPSTF): Final recommendation statement – Elevated blood lead levels in children and pregnant women: Screening (2019)
●American College of Occupational and Environmental Medicine (ACOEM): Arsenic exposure, assessment, toxicity, diagnosis, and management – Guidance for occupational and environmental physicians (2018)
●ACOEM: Position statement on workplace lead exposure (2016)
●Choosing Wisely: Don't perform hair or nail testing for "metal poisoning" screening in patients with nonspecific symptoms (2015)
●Agency for Toxic Substances and Disease Registry (ATSDR): Medical management guidelines for arsenic and inorganic arsenic compounds (updated 2014)
●ATDSR: Medical management guidelines for lead (updated 2014)
●ATDSR: Medical management guidelines for mercury (updated 2014)
●Choosing Wisely: Don't administer a chelating agent prior to testing urine for metals, a practice referred to as "provoked" urine testing (2013)
●Choosing Wisely: Don't order heavy metal screening tests to assess non-specific symptoms in the absence of excessive exposure to metals (2013)
●Choosing Wisely: Don't recommend chelation except for documented metal intoxication which has been diagnosed using validated tests in appropriate biological samples (2013)
●American College of Medical Toxicology (ACMT): Position statement on post-chelator challenge urinary metal testing (2009)
●American Association of Poison Control Centers (AAPCC): Elemental mercury exposure − An evidence-based consensus guideline for out-of-hospital management (2008)
●Association of Occupational and Environmental Clinics (AOEC): Medical management guidelines for lead-exposed adults (revised 2007)
●AAP: Policy statement on lead exposure in children − Prevention, detection, and management (2005)
Europe
●European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN): Consensus statement on arsenic in rice − A cause for concern (2015)
●European Food Safety Authority (EFSA): Scientific report on dietary exposure to inorganic arsenic in the European population (2014)
United Kingdom
●Public Health England (PHE): Guidance on arsenic − Health effects, incident management and toxicology (2014, updated 2019)
●PHE: Guidance on cadmium − Health effects, incident management and toxicology (2014, updated 2019)
●PHE: Guidance on lead − Health effects, incident management and toxicology (2014, updated 2019)
●PHE: Guidance on mercury − Health effects, incident management and toxicology (2012, updated 2019)
●Choosing Wisely UK: Royal College of Emergency Medicine − Review the routine use of urine toxicology tests in patients who are poisoned (2018)
●PHE: Guidance on chromium − Health effects, incident management and toxicology (2014, updated 2017)
Australia-New Zealand
●Northern Territory Department of Health: Elevated blood lead levels – Clinical guidelines and public health management (2017)
●The Australian Health Protection Principal Committee (AHPPC): Australian clinical guidelines for acute exposures to chemical agents of health concern − A guide for the emergency department staff, 2nd edition (2015)
●Northern Territory Department of Health: Arsenic poisoning − Guidelines for health care providers in the Northern Territory (2011)
Japan
●Food Safety Commission Japan (FSCJ): Risk assessment report on arsenic in foods (chemicals and contaminants) (2013)
