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Lead poisoning

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Introduction

Lead is a heavy metal, ubiquitous in our environment that has no physiologic role in biological systems. Lead toxicity is a particularly insidious hazard with the potential of causing irreversible health effects associated with chronic toxicity.

Risk Factors

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Signs and symptoms

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Diagnostic criteria

The clinical presentation varies widely, depending upon the age at exposure, the amount of exposure, and the duration of exposure

New born:

• Born prematurely
• Lower birth weight
• Slowed growth

Children:

• Developmental delay
• Learning difficulties
• Irritability
• Loss of appetite
• Weight loss
• Sluggishness
• Fatigue
• Abdominal pain
• Vomiting
• Constipation
• Hearing loss
• Seizures
• Eating things such as paint chips that aren't food (pica)
• Lower IQ
• Anxiety
• Depression
• ADHD Like symptoms

Adults:

• High blood pressure
• Joint and muscle pain
• Difficulties with memory or concentration
• Headache
• Abdominal pain
• Mood disorders
• Reduced sperm count
• Abnormal sperm
• Miscarriage
• Stillbirth or premature birth in pregnant women
• Anaemia
• Fanconi’s syndrome
• Wrist drop

Investigations

• Lead blood levels <10 µg/dL
• Free erythrocyte protoporphyrin (FEP) level
• FBC
• Imaging studies according to presentation,-chest, bones, abdomen etc are ordered as appropriate.

Treatment

  • Non-pharmacological

    • Remove the source of lead exposure
    • Closely monitor cardiovascular and mental status
    • Maintain an adequate urine output
    • Assess renal and hepatic functions

  • Pharmacological

    Blood Lead levels are 25–40 µg/dL

    • Give D-penicillamine 30-40mg/kg/day PO 1-6months, 2hours before or three hours after meals

    Blood Lead levels are 45–70 µg/dL Chelate the patient using

    • 2,3-Dimercapto-succinic acid (DMSA or succimer) 10mg/kg by deep IM, 8 hourly for 5 days, followed by 10mg/kg 12hourly for 14 days.

    Blood Lead levels of <70 µg/dL and/or encephalopathy

    • Dimercaprol 3mg/kg deep IM 4 hourly for 48 hours followed by 3mg/kg 12 hourly for 10 days
    AND
    • Ethylene diamine tetra-acetic acid (CaNa2 EDTA) IV 10mg/kg 8hourly for 5 days

Prevention

Educate the patient on Dos and Don’ts of poisoning prevention.

Do’s

• Keep medicines and poison in proper containers and out of reach of children
• Use containers with child resistant caps
• Keep all products in their original container
• Read medicine labels carefully to avoid mistake

Don’ts

• Leave container open
• Transfer products from their origin
• Remove labels from the medicine products
• Put tablets into another containers such as purse or envelope
• Medicine/tablets as sweet
• Take your medicine in front of children as they often copy

Updated on,

14 Novemba 2020 15:00:39

References

    1. STG
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