LEAD POISONING

What Is Lead Poisoning?

also known as saturnism, plumbism or painters
colic
Cause by increased level of lead in blood
Lead can enter any cell so toxicity may occur in any
tissue or organ
Even small amount of lead can cause severe
lasting harm, esp to children
No level of lead exposure is safe
Level of concern is 10mcg/dL for children &
25mcg/dL for adults

Main Causes Of Lead

Poisoning

Automobile emission

- In early 90s ,tetraethyl lead added to

gasoline.
- nowadays gasoline usually lead free so
drop in
emission
- however lead already deposited in soil
after
decades of burning

Drinking water
- lead was used in household plumbing
material
in earlier days.

Causes of Lead Poisoning- continued

Agricultural soil
- soil get contaminated with lead either fr lead dust dislodged fr
deteriorated paint or due to irrigation with water contaminated by
lead pipes or lead mining.
- auto-emission also contributed a significant amount of lead in
soil.
- the lead get taken up by crops or may stick onto plants & get
ingested.
Lead paint
- some paints may contain lead chromate & lead carbonate as it
speeds up drying & resist moisture.
- children can be exposed to lead by eating & chewing an object
painted with these paints or swallow house dust that contain lead.
Toys
- toys may be painted or made up of plastic that contain lead.

What Happens When Lead Enters The

Body ?
Lead enters the blood stream & circulates
throughout body
Body tries to excrete the lead
Some deposits in soft tissues such as
kidneys, lungs, brain, spleen, muscles,&
heart
Majority (95%) moves into bones & teeth
( some into hair )
Lead is removed from the body extremely
slowly

Effects Of Lead In The Body

Biochemical Effects
Lead inhibits or mimics the action of
calcium
This can affect calcium-dependent or
related processes
Enzyme functions decreased as lead bind
to protein components of enzymes and
interfere with their ability to catalyse their
normal reactions

Effects Of Lead In The Body

Neurological/ Behavioral Effects
Encephalopathy rare
BLL > 70-80 mcg/dL
Signs & symptoms : hyperirritability, ataxia,
convulsions,
stupor (near unconscious), coma, death
Disruption of balance
Impaired peripheral nerve functions
Hearing impairment
IQ loss
ADHD
Deficits in vocabulary, fine motor skills, reaction times,
hand-eye coordination
Delinquent & aggressive behaviour

Effects Of Lead In The Body

Hematological Effects
Lead inhibits haemoglobin synthesis
This interferes with other haeme-dependent
processes
Lead shortens the average lifespan of RBCs

Cardiovascular Effects
Studies have linked lead to hypertension ( incl.
low lead exposure )
ECG abnormalities, degenerative changes in
cardiac muscle

Effects Of Lead In The Body

Renal Effects
Proximal tubules of kidneys are sensitive to lead
levels > 25mcg/dL
Lead forms protein complexes that lead to fibrous
connective tissue & gout

Gastrointestinal Effects

Colic is a consistent early symptom of exposure

Abdominal pain
Constipation
Cramps
Nausea & vomiting
Anorexia
Weight loss

Effects Of Lead In The Body

Other Effects
Auditory : negative impact on auditory functions
Endocrine : in human growth hormone
Vit D metabolism : interferes with the conversion
of vit D to its hormonal form
Growth : growth retardation in height, weight &
chest circumference
Reproductive : sperm count
abnormal sperm
miscarriages, stillbirth & premature birth
Impotency

Why Are Children At Greatest

Risk ?
Greater exposure
- high hand-to-mouth activity
- crawling, chewing & sucking
- play in dirt and/or on floor
Higher lead absorption rate children
absorb up to 50% of ingested lead , while
adults only 10%
Negative Impact on nervous system
development

The Warning Signs Of Lead

Poisoning

Lead poisoning is an invisible danger

Children with lead poisoning do not always
look or act sick
Signs & symptoms:
- general fatigue & lethargy
- hyperactivity & ADHD (attention-deficit/ hyperactivity disorder)
- irritability
- colic (abdominal pain )
- trouble sleeping
-myalgia (pain in the muscle) or paraesthesia
- headaches
- tremor

Treatment Of Lead Poisoning

Chelation therapy is used if lead level is high
Chelation rapidly reduces the amount of lead stored in
body.
Chelated lead is eliminated fr the body through the
kidneys
EDTA ( ethylenediaminetetraacetic acid ) is given by
IV maybe combined with dimercaprol
Prevention is the most effective means of reducing or
eliminating lead poisoning
This therapy may not reverse the damage that
already occurred in severe cases.
Children with lead toxicity may also be iron deficient
so iron supplements needed .

Chelating Agents
Dimercaprol ( British Antilewisite, BAL )
1st chelator used in encephalopathic pt
Rapidly crosses the BBB
More effective at preventing lead from forming
bonds with tissue than reversing it
Usually used in combination with EDTA
Has a typical sulphide odour pt often complain
of bad taste & feeling
A/E : fever, pain at injection site, N/V, headache
Dose : 3-5mg/kg IM q4h ( adults & children )

Chelating Agents
EDTA ( Edetate calcium disodium )

Nearly the perfect chelator

Is water soluble can be used IV or IM
Allows lead to be renally excreted
It is not metabolised & have few s/e
IM extremely irritating to muscle & painful
- can be used with lignocaine or procaine to
lessen pain
Dose : 50-75mg/kg/d IV continuous infusion over
8-24 hr for 5 days or given IM in 2-6 divided doses

Chelating Agents
Succimer ( DMSA )
Only drug approved by FDA specifically for lead
chelation in children
Shown to be an effective oral chelator
Almost as effective as EDTA & BAL
Produce a rapid decline in lead levels & reverses
many of the biochemical indicators of toxicity