Posts tagged "Lead lines"

Lead Poisoning: Treatment

Clinical manifestations of lead poisoning: Abdominal pain, lethargy, anorexia, irritability, anemia, Fanconi’s syndrome, pyuria (pus in urine), azotemia in children with blood lead level of more than 80µg/100ml. Epiphyseal plate “lead lines” can be seen on X-ray of long bones. Convulsions, coma, and death can occur if blood lead level is more than 120µg/100ml. CDC Atlanta, USA recommends screening of all children at the time of crawling age (about 6 months) source identification and intervention is begun if the BPb (blood lead level) is more than 10 µg/100ml. Neurodevelopmental delays are seen at BPb of 40–80 µg/100ml. Headaches, arthralgias (joint pain), myalgias, depression, impaired short-term memory, loss of libido are common symptoms of lead poisoning. Examination may reveal a “lead line” at the gum-tooth border, pallor, wrist drop.

Diagnosis: Diagnosis is mainly by history, clinical symptoms and blood lead levels.  Laboratory tests may reveal a normocytic, normochromic anemia, an elevated blood protoporphyrin level, and motor delays on nerve conduction. In the U.S., regular testing of lead-exposed workers with removal if BPb is more than 40 µg/100ml is mandatory. K-X-ray fluorescence (KXRF) instruments have made it possible to measure bone lead levels which can diagnose a chronic lead poisoning even if it is at subclinical level.

Treatment: Source of the poisoning should be identified and corrected. Chelation is recommended with oral DMSA (succimer). Severe toxic cases should be hospitalized and IV (intravenous) or IM (intramuscular) chelation with edentate calcium disodium (CaEDTA) is administered. Dimercaprol is given to prevent worsening of encephalopathy. Correction of dietary deficiencies of iron, calcium, magnesium, and zinc lower lead absorption and also can improve the toxic condition. Vitamin C is a weak and natural chelating agent.

Chelation should be done or not in children with asymptomatic lead poisoning (blood lead level 20-40 µg/100ml) are not clear.

Related Posts Plugin for WordPress, Blogger...

Be the first to comment - What do you think?
Posted by - November 8, 2008 at 2:00 pm

Categories: Uncategorized   Tags: , ,