Emergency Medicine Book

http://www.fpnotebook.com/

Lead PoisoningAka: Lead Intoxication, Lead Toxicity

Advertisement

  1. Causes
    1. Pica secondary to Anemia
      1. Eating lead paint or soil
    2. Household dust
    3. Drinking water from lead pipes
    4. Industrial waste exposure
    5. Residence near busy highway
    6. Parents with occupational exposure
      1. Lead production or smelting
      2. Battery manufacturing
      3. Brass, copper or lead foundry
      4. Radiator repair
      5. Scrap handling
      6. Ship and bridge demolition
      7. Old painted metal welding
      8. Thermal paint stripping of old buildings
      9. Old paint sanding
      10. Lead soldering
      11. Ceramic glaze mixing
      12. Cable stripping
      13. Firing range staff
      14. Machining or grinding lead alloys
  2. Symptoms
    1. Anorexia
    2. Headache
    3. Abdominal Pain
    4. Nausea and Vomiting
    5. Constipation
  3. Signs
    1. Lead line in gums
    2. Papilledema
    3. Ocular palsy
    4. Wrist drop
    5. Foot drop
    6. Slurred speech
    7. Reflex changes
    8. Mental status changes
      1. Seizures
      2. Delirium
      3. Coma
  4. Labs
    1. Serum Lead Level >1.2 umol/L
    2. Urine lead level elevated
    3. Peripheral Smear
      1. Stippled erythrocytes
    4. Complete Blood Count (CBC)
      1. Microcytic Anemia
      2. Leukocytosis
    5. Urine microscopy of sediment or renal biopsy
      1. Acid-fast inclusion bodies in tubular nuclei
      2. Pathognomonic for lead poisoning
    6. Free Erythrocyte Protoporphyrin (FEP) > 0.6 umol/L
  5. Radiology: Long bone XRay
    1. Epiphyseal lead line
  6. Management: Lead chelation
    1. Edetate
      1. Dose: 0.5-1.0 g/m2/day
      2. Maximum: 1.5 grams per day
    2. Dimercaprol
      1. Dose: 12-24 mg/kg/day for 5 days
    3. Penicillamine
      1. Dose: 20-40 mg/kg/day for 3 to 6 months
      2. Maximum: 1 grams per day
    4. Meso-2,3-dimercaptosuccinic acid (DMSA)
      1. Dose: 10 mg/kg PO every 8 hours for 5 days
    5. Efficacy
      1. Chelation not affective if lead <45 mcg/dl
      2. Dietrich (2004) Pediatrics 114:19
  7. Prognosis (Untreated)
    1. Aggressive and delinquent behavior
    2. Mental retardation
    3. Language and cognitive deficits
    4. References
      1. Needlman (1996) JAMA 275:363
  8. Prevention
    1. Precautions regarding drinking water from lead pipes
      1. Allow tap to flow for 30 seconds, then collect water
      2. Do not use hot water from tap for drinking
    2. Avoid living near highways or industrial plants
    3. Replace all lead paint with non-lead paints
      1. Carefully limit child's exposure during remodeling
      2. Carefully dispose of removed lead paint
  9. References
    1. Chao (1993) Am Fam Physician 47:113

Lead Poisoning (C0023176)

Definition (CSP)poisoning due to absorption or ingestion of lead or one of its salts; symptoms include loss of appetite, weight loss, colic, constipation, insomnia, headache, dizziness, irritability, moderate hypertension, albuminuria, anemia, encephalopathy, and peripheral neuropathy leading to paralysis.
ConceptsInjury or Poisoning (T037)
ICD9961.2, 984, 984, 984.9
MSHD007855
EnglishLead - toxic effect, Lead and lead compounds causing toxic effect, Lead compound poisoning, LEAD POIS, Lead Poisoning, Lead Poisonings, Plumbism, POIS LEAD, Poisoning by compounds of lead, Saturnine poisoning, SATURNISM, Toxic effect of lead and its compounds, Toxic effect of lead compound, Toxic effect of unspecified lead compound
Spanishefecto toxico del plomo, intoxicacion plumbica, intoxicacion por compuesto de plomo, intoxicacion por plomo, intoxicacion saturnina, plumbismo
Parent ConceptsToxic effect of heavy metal (C0274869), Lead Poisoning (C0023176), Toxic effect of chiefly nonmedicinal substance (C0274829), Poisoning (C0032343), Poisoning by heavy metal anti-infective (C0161499), Duplicate concept (C1274013)
SourcesCOSTAR, CSP, DXP, ICD9CM, MEDLINEPLUS, MSH, MTHICD9, NCI, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree