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Information about lead poisoning complications,lead poisoning differential diagnosis,treatment of lead poisoning ect info

Here you can find information about etiology and pathology of lead poisoning,laboratory examination of lead poisoning,lead poisoning prevention

Lead accumulates slowly in the body and even low doses can eventually lead to poisoning. Serum level of lead at which treatment is indicated in young children is 100mcg/l. 95% of lead in body is deposited in bones and teeth while 99% of lead in blood is associated with erythrocytes. Lead poisoning can cause nervous system toxicity and renal tubular dysfunction leading to irreversible interstitial nephrosis with progressive renal impairment and hypertension. Lead also depresses haem synthesis and shortens life span of erythrocytes causing a hypochromic microcytic anaemia.

Epidemiology
Incidence A lot less common than it used to be with less use in petrol, paints or cosmetics and generally improved housing.
Risk Factors

  • Reclamation of lead from scrap metal, battery manufacture and other industries where lead is involved
  • Children chewing lead painted items or ingesting fishing weights, bullets or contaminated soil.
  • Use of various imported tonics and cosmetics containing lead. 3
  • Associated iron deficiency (increases lead absorption from GI tract).
  • Poor/old housing (lead paint or pipes).
  • Use of lead-containing folk remedies.
  • Age - compared to an adult, a child can absorb twice as much lead from the GI tract.

Presentation
Symptoms Mild poisoning - lethargy with occasional abdominal discomfort. 2

Severe poisoning - usually diffuse abdominal pain but may be colicky, vomiting, constipation and encephalopathy. Latter is more common in children with seizures, mania, delirium and coma. Foot drop due to motor peripheral neuropathy is a classic sign. Wrist drop is a late sign.

Headaches, hearing loss, carpal tunnel syndrome and sub-fertility can also occur.

Signs May see blue discoloration of gum margins.

Investigations Serum lead levels (normal <100mcg/l), blood film (basophilic stippling of erythrocytes), FBC, X-ray fluorescence to estimate total body burden. Lead lines may be visible in growing bones.

Toxic Blood Levels
<100mcg/l - Normal.
>100mcg/l - May cause impaired cognitive development in children.
>450mcg/l - GI symptoms in adults and children. Oral chelation therapy should commence.
>700mcg/l - High risk of acute CNS symptoms. Parenteral chelation treatment should be commenced.
>1000mcg/l - may be life threatening.

Management
Drugs In severe poisoning with encepalopathy: Dimercaprol (BAL) and calcium disodium edetate (given parenterally), or if less severe and no encephalopathy: DMSA (Succimer) can be given by mouth. Penicillamine has also been used for decades as an unlicensed oral alternative.

Note that if chelation therapy is ceased prematurely the blood levels can rebound due to movement of the metal out of the bony stores.

Prevention Stopping working with lead at serum > 600-700mcg/l.

References Used

  1. Proudfoot AT and Vale GA in Oxford Textbook of Medicine, 4th Edition. Eds; Warrell DA et al. OUP 2003.
  2. Sood A, Midha V, Sood N; Pain in abdomen - do not forget lead poisoning.;Indian J Gastroenterol 2002 Nov-Dec;21(6):225-6.[abstract]
  3. Ibrahim AS, Latif AH; Adult lead poisoning from a herbal medicine.;Saudi Med J 2002 May;23(5):591-3.[abstract]

Acknowledgements EMIS is grateful to doctoronline.nhs.uk for facilitating draft authoring of this article. The final copy has passed peer review of the independent Mentor GP authoring team. ?EMIS 2004.


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