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LEAD POISONING, Therapy regimen, PREVENTION, d29122fcfd9d22b547fa429800f2d…
LEAD POISONING
COMPLICATIONS
Renal
- Has an effect on renal function even at levels below 10 mcg/dL(0.48 micromol/L).
- Exposure of lead for a sustained period of time may affect his renal function. Renal function should be evaluated.
Gastrointestinal
- Lead colic; sporadic vomiting, intermittent abdominal pain, and constipation may occur.
- This patient experienced vomiting and should be monitored to prevent dehydration.
Hearing loss
- Occurs in the higher frequencies and may contribute to learning and behaviour problems
Endocrine
- Vitamin D metabolism is decreased at blood lead level of 30 mcg/dL (1.45 micromol/L).
- The effects of lead toxicity on cell growth and maturation and tooth and bone development increased absorption of lead can occur, especially in children who have decreased calcium intake.
- Evaluate calcium level and consider calcium supplementation.
Acute encephalopathy
- He should also be evaluated for acute encephalopathy if the blood lead level is greater than 100 to 150 mcg/dL.
- Associated with inappropriate antidiuretic hormone secretion, partial heart block, and marked decrease in renal function.
Hematologic
- Anemia is due to decreased hemoglobin synthesis at blood lead level of 40 mcg/dL (1.9 micromol/L) and interference of lead with several enzymatic steps in the heme pathway.
- Anemia secondary to lead toxicity usually is mild, hemolytic, and normocytic.
- This patient should be evaluated for iron deficiency to distinguish whether the anemia is secondary to lead toxicity or due to iron deficiency.
Neurologic effects
- Lead exposure at <7.5 mcg/dL (0.36 micromol/L) is associated with cognitive deficits.
- He is significant for an ataxic gait on his neurological examination. Further monitoring on neurological function should be done.
PATHOPHYSIOLOGY
Lead can be ingested from contaminated water, lead based paint, dust and other materials
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Lead can cross the underdeveloped blood brain barrier of children to affect hippocampal neurons crucial for learning and memory
Lead inactivates glutathione by binding to GSH’s sulfhydryl group, which causes GSH replenishment to become inefficient, thereby increasing oxidative stress.
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Therefore, patient experience delayed or reversed development, permanent learning disabilities, seizures, and even death.
CAUSES
Certain occupations such as mining, pipe fitting, battery manufacturing, painting and construction
Paint and dust chips from old toys, furniture, and pottery glazes
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RISK FACTOR
Age (Patient is 7 years old; younger children are at higher risk of lead exposure because their bodies are still growing)
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ACUTE/CHRONIC
Acute
can occur rarely from industrial exposures and in children who have ingested large quantities of chips or flakes from surfaces in older houses covered with lead-containing paint
Primary sign: acute abdominal colic, acute encephalopathy and central nervous system (CNS) changes
Chronic
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Signs: peripheral neuropathy (wrist-drop is characteristic), anorexia, anemia, tremor, weight loss, and gastrointestinal symptoms
Chronic lead poisoning in children: growth retardation, neurocognitive deficits, and developmental delay
Case (Chronic)
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anemic, thus his serum level is high
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difficulty in walking, irritable and quite tired, and vomiting
FURTHER LABORATORY DATA
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Blood lead level
:check: reasonable approximation of lead exposure,
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PATIENT MONITORING
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check surrounding lead
if environment is lead free, consider to discharge patient
TREATMENT
Anemic condition
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Ascorbic acid
Helps in intestinal absorption of supplemental iron, esp. in low levels of serum iron
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Lead Poisoning
Dimercaprol
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ADR: headache, naesua, vomiting, tachycardia, fever (esp. in children), pain at injection site etc.
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Bidentate chelator, that is a chelator that forms 2 bonds with the metal ion preventing the metal binding to the tissue proteins and permitting its rapid excretion from the blood
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EDTA
To prevent dangerous hypocalcemia, EDTA is given as the calcium disodium salt.
ADR: nephrotoxicity, including renal tubular necrosis
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Therapy regimen
Dosing
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Initially, 4mg/kg followed by 3-4mg/kg at 4 hourly intervals
Maintenance: Parenteral chelation is limited to 2-7 days; Oral treatment with another chelator, succimer may be instituted.
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PREVENTION
Methods
Wash hands and toys. To help reduce hand-to-mouth transfer of contaminated dust or soil, wash children's hands after outdoor play, before eating and at bedtime. Wash their toys regularly.
Clean dusty surfaces. Clean floors with a wet mop and wipe furniture, windowsills and other dusty surfaces with a damp cloth.
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Run cold water. If parents house have older plumbing containing lead pipes or fittings, run your cold water for at least a minute before using. Don't use hot tap water to make baby formula or for cooking.
Prevent children from playing on soil. Provide them with a sandbox that's covered when not in use. Plant grass or cover bare soil with mulch.
Eat a healthy diet. Regular meals and good nutrition might help lower lead absorption. Children especially need enough calcium, vitamin C and iron in their diets to help keep lead from being absorbed.
Keep your home well-maintained. If the home has lead-based paint, check regularly for peeling paint and fix problems promptly. Try not to sand, which generates dust particles that contain lead.
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