The worker is ladling molten recycled lead into billets in a lead-acid battery recovery facility. Lead is an extremely toxic substance and workers must be protected from its effects. Any manufacturing operation involving lead has the potential for overexposure, and so the elements of a lead program (including provision of work clothes and PPE) are in place here | National Institute for Occupational Safety and Health (NIOSH) from USA - Recycling lead in a lead-acid battery recovery facility, Public Domain, https://commons.wikimedia.org/w/index.php?curid=5334658
Contents
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:
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
Dense metaphyseal lines from lead poisoning | Dr Abhijit Datir – http://radiopaedia.org/cases/lead-poisoning, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11343872
Basophilic stippling (arrows) of red blood cells in a 53-year-old who had elevated blood lead levels due to drinking repeatedly from glasses decorated with lead paint. | Herbert L. Fred, MD and Hendrik A. van Dijk – http://cnx.org/content/m15003/latest/, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=5038848
The brains of adults who were exposed to lead as children show decreased volume, especially in the prefrontal cortex, on MRI. Areas of volume loss are shown in color over a template of a normal brain | Cecil KM, Brubaker CJ, Adler CM, Dietrich KN, Altaye M, et al. – Decreased Brain Volume in Adults with Childhood Lead Exposure. PLoS Medicine Vol. 5, No. 5, e112 doi:10.1371/journal.pmed.0050112, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=4474230
Lead exposure damages cells in the hippocampus, a part of the brain involved in memory. Hippocampi of lead-exposed rats (bottom) show structural damage such as irregular nuclei (IN) and denaturation of myelin (DNS) compared to controls (top). | Xu, J; Yan, Hc; Yang,B; Tong, Ls; Zou, Yx; Tian, Y (Apr 2009). “Effects of lead exposureon hippocampal metabotropic glutamate receptor subtype 3 and 7 indevelopmental rats” Journal of negative resultsin biomedicine 8: 5. doi:10.1186/1477-5751-8-5. PMID 19374778. PMC:2674876. http://www.jnrbm.com/content/8//5., CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=7713948
Clinical types:
Exposure
Lead levels (µg/dl)
Clinical symptoms
Acute poisoning
Intense exposure of short duration
100–120
Muscle pain, fatigue, abdominal pain, headache, vomiting, seizures and coma
Chronic poisoning
Repeated low-level exposure over a prolonged period
40–60
Persistent 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
