Lead poisoning

Symptoms and signs:

  1. GI: abdominal pain, constipation, anorexia, lead lines on gum(Burton’s lines)
    Image result for lead lines gum lead poisoning
  2. Neurological : headache, neurocognitive deficits(forgetfullness, encephalopathy, behavior problems, language regression; childrens especially susceptible due to incomplete BBB maturation), motor/sensory peripheral neuropathies(stocking-glove pattern ddx with GBS, DM… etc, extensor weakness)
  3. Hematologic:al microcytic anemia(99% bound to erythrocytes and can disrupt heme synthesis)
  4. Nonspecific signs: fatigue, irritability, insomnia,
  5. Chronic s/s: hypertension, nephropathy

Laboratory findings:

  1. Anemia with small MCVs
  2. Elevated lead levels (X-ray flouresence to measure bone lead concentration)
  3. Increased zinc protoporphyrin levels(replacement of Fe with Zn), delta-aminolevulinic acid levels(D-ALA)
    asdf
  4. Basophilic stippling on peripheral smear(vs ringed sideroblast in bone marrow aspiration)
    Image result for basophilic stippling

Risk Factors:

  1. Occupational exposure such as lead paint, batteries, ammunition, plumbing and construction(home restoration)
  2. Common in poor children in old urban hours built before 1978

Treatment:

Always re-check venous lead level if primary screening test showed elevated levels. Treatment is based on the severity. Levels > 5 mcg/dL are considered elevated

  • Mild 5-44: No medication with repeated measurement in a month
  • Moderate 45-69: Dimercaptosuccinic acid(DMSA)
  • Severe >70: Dimercaprol + Calcium disodium edetate(EDTA)

Here’s a general approach to childhood lead poisoning found on pininterest

Image result for lead poisoning uworld


Here’s an totally unrelated John Oliver’s youtube channel video


Q: 4862

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