lead poisoning
Folk
prescription for treating rhinitis as a rare cause of childhood lead poisoning: a case series. Anteroposterior radiograph of the knees bilaterally
Preschooler
with pica and constipation. AXR AP (left) shows a marked amount of constipation with punctate radioopaque objects throughout the colon, most clearly seen in the magnified AP view of the rectum (center). AP radiograph of the wrist (right) shows a dense line in the metaphysis of the radius.The diagnosis was lead poisoning.
Chronic lead
poisoning induced abdominal pain and anemia: a case report and review of the literature. Physical examination character of CLP. a Burton line in the upper gum (black arrow). b Burton line in the lower gum (black arrow)
Lead poisoning or plumbism is a multisystem condition due to the way in which lead interferes with the function of virtually every organ system. Plumbism most severely manifests due to its devastating effects on the CNS, but it also has important deleterious consequences on the skeletal, renal, hematopoietic, and reproductive systems.
Epidemiology
This condition usually occurs as a consequence of a toxic environment: prolonged ingestion or inhalation of lead-containing material (e.g. contaminated water, paints, batteries).
Clinical presentation
- neuropsychiatric
- amnesia: short term memory
- poor concentration
- ataxia
- dysarthria
- sensory loss and paresthesia in the extremities
- fatigue, sleep problems
- headaches
- depression
- stupor
- GI
- nausea
- abdominal pain
- anemia
- reproductive system
- miscarriages, prematurity, low birth weight
- nephropathy
- impaired childhood development
Pathology
- bones
- lead accumulates in the metaphyses of growing bones, which are the most metabolically-active zones
- lead is an osteoclast-poison, so bone density is increased due to unopposed action of osteoblasts
- anemia is multifactorial
- lead antagonises the enzymes porphobilinogen synthase and ferrochelatase, inhibiting the synthesis of heme
- lead impairs repair of cell membranes leading to increased erythrocyte fragility
Radiographic features
Plain radiograph
- may show bands of increased density at the metaphyses
- can affect any metaphysis, but the involvement of the proximal fibula and distal ulnar metaphyses is highly suggestive
- may show bone-in-bone appearance
Treatment and prognosis
- chelation therapy
- dimercaprol
- dimercaptosuccinic acid (DMSA) (also known as succimer)
- sodium calcium edetate
Differential diagnosis
- healed rickets
- physiological appearances in <3 years' age group
See also
- differential for dense metaphyseal bands
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Bleivergiftung:
