CHRONIC POISONING

Rosshini Jagatheswaran

0901135

Lead Poisoning

Sources

Lead based paint ingestion or inhalationLead fumes from burning batteriesLead shot for fishingLead from old water pipesLead from vehicle exhaust fumes (in the past)

Clinical Features

• Pica• Anorexia• Colicky

abdominal pain• Irritability• Failure to thrive• Pallor

Severe poisoning

• Drowsiness • Convulsions • Coma from lead

encephalopathy • Raised ICP with

papilloedema may be present

*Chronic exposure to low levels may harm cognitive development

Diagnosis

• Gold standard : measuring blood lead levels (<5 µg/dL)

• Hypochromic anaemia and basophilic stippling of neutrophils or RBC

• X-ray of knee or wrist may show ‘lead lines’ (dense metaphyseal bands)

Basophilic stippling of RBC. Erythrocytes display small blue dots at the periphery. These dots are the visualization of ribosomes and can often be found in the peripheral blood smear. Also seen is megaloblastic anemia

Lead poisoning. Opaque metaphyseal bands in the lower femur, upper tibia, and the upper fibula secondary to lead poisoning in a child.

Treatment• Source of lead identified and removed

• A child with a venous BLL 45 μg/dL or higher should be treated with medication

• Chelating agents are used to from non toxic lead compounds

• Mild- Penicillamine (orally)

• Severe- sodium calcium edetate (EDTA) parenteral

Smoking

• Long term effects include chronic bronchitis, lung cancer and cardiovascular disease

• Greater incidence of bronchitis, asthma, pneumonia and serous otitis media in children who parent/carers smoke

• Sudden Infant Death Syndrome

• Health education to children is needed to curb smoking; especially in school going age and adolescents

• Smoking cessation in adolescents includes the 5 A's (Ask, Advise, Assess, Assist, and Arrange) and use of nicotine replacement therapy in addicted teens