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Lead poisoning
Absorption
Skin:
- little/no absorption
Inhalation (<1m):
- dust or lead fumes - absorb 50-70%
Oral:
- adults absorb 10% - children absorb 40-50%
- increased absorption if low Fe, Ca
Lead poisoning
Storage & Distribution
1 Rapid turnover soft tissue pool:
- T1/2 30-40 days; blood, liver, kidney, CNS
- Chronic exposure results in a steady state distribution between bone and blood
Lead poisoning
Occupational
Sources
Environmental
Lead smelters paint (walls, furniture, toys) Painter/decorators water Battery manufacturers food Stain-glass workers air (petrol, industry), dust/soil Jewellery makers Other Bronze workers etc... traditional remedies (Ayruvedic) surma & kohl cosmetics lead shot lead glazed ceramics foreign body ingestion
e.g. curtain/fishing weight, snooker chalk
76 mg/g mercury i.e. 7.6 % 12 mg/g arsenic i.e. 1.2 % i.e. 15.5 % heavy metals
Case 2: 50 mg/g lead i.e. 5.0 % 39 mg/g mercury i.e. 3.9 %
500-700 600-1000
Abdominal pain, constipation, weight loss, loss of appetite Mild anaemia
>700 >1000
Abdominal colic, vomiting
GI Tract Blood
Nil
Severe anaemia
CNS
Fatigue, poor concentration [Peripheral neuropathy] Hypertension, nephrotoxicity, lowered Vit D metabolism
Encephalopathy - delirium - ataxia - fits - coma Hypertension, nephrotoxicity, lowered Vit D metabolism
Other
Nil
Radiology
- AXR ?lead in gut - Long bone XR in children
(children)
3. BAL - Dimercaprol
- IM for severe toxicity only, particularly encephalopathy
Treatment guidelines
Children
100-240g/l : Remove from source, repeat level 1 month 250-440g/l : Remove from source : DMSA only if persists at this level 450-690g/l : Remove from source
: DMSA chelation
>700g/l
Treatment guidelines
Adults