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Internal Medicine

Lead poisoning

Potentially lethal toxicity due to build-up of lead in the body, usually over months or years.

Introduction

Potentially lethal toxicity due to build-up of lead in the body, usually over months or years.


Epidemiology

Public health issue:


Toxicology

Effect on haem synthesis:

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Haem synthesis and the effects of lead | Gordon, J. N., Taylor, A., & Bennett, P. N. (2002). Lead poisoning: case studies. British Journal of Clinical Pharmacology, 53(5), 451–458. https://doi.org/10.1046/j.1365-2125.2002.01580.x

Clinical features

LEAD:

  • Lead lines in gingiva (Burton’s lines) & long bones (dense metaphyseal lines)
  • Encephalopathy & erythrocyte basophilic stippling
  • Abdominal colic & anaemia
  • Drop foot & drop wrist

Clinical types:

 ExposureLead levels (µg/dl)Clinical symptoms
Acute poisoningIntense exposure of short duration100–120Muscle pain, fatigue, abdominal pain, headache, vomiting, seizures and coma
Chronic poisoningRepeated low-level exposure over a prolonged period40–60Persistent vomiting, encephalopathy, lethargy, delirium, convulsions and coma

Case study:


Diagnosis

Blood panel:

  • Lead ≥ 5μg/dl
  • Normal serum iron levels
  • Microcytic anaemia
  • Basophilic stipling (ribosomes)

Management

Stop exposure

Chelation therapy:

If lead > 45 μg/dl in children or > 70 μg/dl in adults
  • Dimercaprol (encephalopathy present)
  • Succimer (no encephalopathy)

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