Lead Poisoning

(Plumbismus)

Lead poisoning solve common initially, only minor complaints, but can also lead to acute encephalopathy or irreversible organ damage, which usually manifests itself in children in the form of cognitive deficits. The diagnosis can be made based on the concentration of lead in whole blood. The treatment includes stopping the exposure to lead and sometimes a Chelatbildnertherapie with Dimercaptoporpansulfonsäure (DMPS), or calcium disodium EDTA with or without dimercaprol.

There is no measurable blood lead levels that do not cause harm. The Centers for Disease Control and Prevention (CDC) recommend that children identification and elimination of lead source is to be carried out with blood lead levels> 5 g / dl, a repeat of the lead determination, and serial monitoring and evaluation on vitamin deficiency and the general nutritional status.

Lead poisoning solve common initially, only minor complaints, but can also lead to acute encephalopathy or irreversible organ damage, which usually manifests itself in children in the form of cognitive deficits. The diagnosis can be made based on the concentration of lead in whole blood. The treatment includes stopping the exposure to lead and sometimes a Chelatbildnertherapie with Dimercaptoporpansulfonsäure (DMPS), or calcium disodium EDTA with or without dimercaprol. There is no measurable blood lead levels that do not cause harm. The Centers for Disease Control and Prevention (CDC) recommend that children identification and elimination of lead source is to be carried out with blood lead levels> 5 g / dl, a repeat of the lead determination, and serial monitoring and evaluation on vitamin deficiency and the general nutritional status. Etiology Lead paint was commonly used until 1960 and partly to the 1970s in until the production of these coatings has been set 1978th Thus, for a large number of older houses lead paint still some risk. The lead poisoning is usually caused by direct ingestion of lead paint exfoliated. At home renovations patients may be exposed to significant amounts of lead dust that is produced by scraping and sanding of surfaces before applying the new paint. From ceramics with lead glaze, such as those found outside the US / Europe, lead can be released (eg. As fruits, cola drinks, tomatoes, fruit wines) mainly by acidic substances. Leaded, illicitly distilled whiskey and popular traditional remedies are possible sources as well as occasionally lead-containing foreign bodies in the stomach or tissue (eg. As missiles / projectiles, curtain or fishing weights). Bullets / projectiles in soft tissue (especially near the spinal cord) may result in an increase in the concentration of lead in the blood, but it takes up to that year. (N. D. Ed .: Also shooters at shooting ranges, an increased exposure to lead may have.) A occupational exposure is observed in the production and recycling of batteries, when burnishing, in the brass and glass production, in the cutting of pipes, during soldering, welding and metal melts or pottery and working with pigments. Some popular traditional cosmetics and imported herbal products and herbal remedies contain lead and have led immigrants to mass poisoning with lead. Fumes from leaded gasoline (in countries outside the United States or Europe) that are inhaled misused with the aim of a CNS effect, can cause lead poisoning. Symptoms and complaints The Lead poisoning is usually a chronic disease and must show no acute symptoms. With or without acute symptoms, the poisoning manifested by ultimately irreversible damage (eg. As cognitive disorders, peripheral neuropathy, progressive renal insufficiency). The symptoms of lead poisoning correlate with the Stay values, but there are no levels of lead in the blood that can be considered dangerous. The risk for the occurrence of cognitive impairment increases as the concentration of lead in whole blood (PBB) for an extended period ? 10 g / dL (? 0.48 .mu.mol / L), wherein the limit value is perhaps even lower. Other symptoms (eg. B. abdominal cramping, constipation, tremor, mood swings) can> 50 ug / dL (> 2.4 mol / L) occur at PbB. Encephalopathy is likely when the PbB at more than> 100 ug / dL (> 4.8 mol / L). In children In children, acute lead poisoning irritability, attention deficits and acute encephalopathy may cause. Cerebral edema develops over 1-5 days and leads to persistent, severe vomiting, atactic gait disturbances, seizures, impaired consciousness and eventually intractable seizures and coma. The encephalopathy may be preceded by several weeks episode of irritability and reduced-play drive. Chronic lead poisoning leads children to mental retardation, seizures, aggressive behavior disorders, developmental delay, chronic abdominal pain and Anämie.Bei adult adults with a commercial exposure develop symptoms (eg. As personality changes, headache, abdominal pain, polyneuropathy) characteristically over several weeks or possibly over an even longer period. Encephalopathy is unusual. In adults, loss of libido, infertility and, in men, erectile dysfunction auftreten.Bei children and adults can at children and adults, anemia can develop, as Lead interferes with Hb formation. Children and adults who tetraethyl or tetramethyl lead inhale (in leaded petrol) may additionally develop a toxic psychosis with the more pronounced, typical symptoms of lead poisoning. Diagnosis lead concentration in capillary whole blood or the characteristic symptoms lead to the diagnosis of lead poisoning. But because the symptoms are often nonspecific, the diagnosis of lead poisoning occurs often delayed. For the diagnosis of the blood analysis and the measurement of serum electrolytes, BUN, serum creatinine, plasma glucose and concentration of lead in whole blood include (PBB). An X-ray examination of the abdomen should be performed to detect radiopaque lead particles. In children, an x-ray of the long bones is made. The horizontal, located in the metaphysis lead lines are an expression of a disturbed erythrocyte formation and increased calcium deposition in the zones provisional calcification of the bones of the children reasonably specific, not sensitive enough for poisoning with lead or other heavy metals but. A normocytic or microcytic anemia suggests a lead poisoning is especially if the reticulocyte count increased or watching a basophilic stippling of red blood cells; However, their sensitivity and specificity are limited. The diagnosis is ensured if the concentration of lead in whole blood (PBB) is ? 5 g / dL. Since the PbB determination is not always possible and can also be expensive, other preliminary screening tests can be used for lead poisoning. All positive screening tests should be confirmed by the determination of lead in whole blood. The determination of red cell protoporphyrin (also zinc protoporphyrin or free erythrocyte protoporphyrin called) is often inaccurate and is now rarely performed. Children with PbB> 5 g / dl should be clinically examined and, if necessary, with studies on nutritional and vitamin deficiencies (eg. As iron, calcium and vitamin C deficiency). Provocative testing Provokative urine tests on metal lead and other metals operate on the basis of chelating agents (eg. B. dimercaptopropanesulfonic acid, Kalziumdinatriumedetat), which are given to the patient. Then excreted in urine metal levels are measured. These tests have not been scientifically verified, could have no advantages and can even be dangerous, v far. a. in patients with suspected metal poisoning. Therapy elimination of lead source (eg., By enema when lead in the gastrointestinal tract is) treatment with chelating agents for adults with symptoms of intoxication plus. A PbB> 70 g / dL treatment with chelating agents for children with encephalopathy or a PbB> 45 ug / dL (> 2.15 mmol / L), applies to all patients that lead exposure must be eliminated. If lead-containing debris are visible in the abdominal X-ray, an intestinal lavage is performed with a polyethylene glycol-electrolyte solution in an adult dose of 1-2 L / h, or in a children’s dose of 25-40 mlLkg / h, until the X-ray image does not contain lead is more visible. Administration through a nasogastric tube may be necessary to introduce these large volumes, which must be taken to ensure that the airway is protected; intubation may be necessary. Are basement balls the cause, surgical removal in should be considered. Children with PbB> 70 g / dL (> 3.40 mol / l) and all patients with neurological symptoms should be hospitalized. Patients with acute encephalopathy are taken to intensive care. Chelating agents such. B. DMPS, dimercaptopropanesulfonic acid, CaNa2EDTA may be added, to convert lead in a renal excretable form. A Chelatbildnertherapie should be supervised by an experienced toxicologists. The indication for Chelatbildnertherapie is given in adult patients with symptoms of poisoning and simultaneously PbB> 70 g / dL and in children with encephalopathy or a PbB> 45 g / dL (> 2.15 mol / L). Liver and kidney disease are relative contraindications to chelating agents. Chelating agents should not be given to a persisting lead exposure because the chelation can enhance gastrointestinal Bleiresorption. A chelation therapy removes only relatively small amounts of metal. For very large total body burden of lead multiple chelation therapy over many years may be required. Dosing patients with encephalopathy every 4 hours with dimercaprol 75 mg / m2 (or 4 mg / kg) i.m. and CaNa2 EDTA i.v. 1000-1500 mg / m2 (Infusion) once daily. The first dimercaprol dose should be given at least 4 hours prior to the first CaNa2 EDTA dose, to prevent redistribution of the lead in the brain. Dimercaprol can be discontinued after a few doses depending on the concentration of lead and the severity of the symptoms. The dimercaprol CaNa2EDTA therapy is given five days followed by a 3-day washout period. Following this, the need for further chelation is checked again. (N. D. Talk .: Because dimercaprol is no longer available on the German market, lead poisoning are treated in this country either with imported DMSA and EDTA CaNa2 or DMPS.) The treatment of patients without encephalopathy is usually with DMSA (succimer) 10 mg / kg po every 8 hours for 5 days, followed by 10 mg / kg p.o. every 12 hours for 14 days. Symptomatic patients can alternatively for 5 days with dimercaprol 50 mg / m2 i.m. deep every 4 hours and CaNa2 1000 mg / m2 i.v. every 24 hours treated werden.Medikamentöse treatment DMPS may cause allergic skin reactions, fever and chills. Repeated dose liver function tests should be checked. Dimercaprol can also cause a moderate degree to severe acute intravascular hemolysis pain around the injection site, numerous systemic symptoms and in patients with G6PD deficiency. This drug should not be administered concurrently with an iron supplement. Dimercaprol is cooked with peanut derivatives and is therefore contraindicated in patients with known or suspected peanut allergy. CaNa2EDTA can cause thrombophlebitis, which can be avoided if the drug i.m. and not i.v. is added and a solution that is not concentrated than <0.5%. Before initiation of therapy with CaNa2EDTA adequate diuresis must be secured. Among the serious reactions to CaNa2EDTA include renal failure, proteinuria, microscopic hematuria, fever and diarrhea. The renal injury is dose-dependent and usually reversible. The side effects of CaNa2EDTA are probably due to a Zinkdepletion. Succimere can cause skin rashes, gastrointestinal symptoms (eg. As loss of appetite, nausea, vomiting, diarrhea, metallic taste) and a transient increase in liver enzymes verursachen.Niedrigere lead levels patients with PbB be> 5 g / dl should be closely monitored and informed about it (in pediatric patients parents), as the lead exposure can be reduced. Prevention patients with an increased risk should be monitored by means of PbB measurement. Among the measures that can reduce the risk of poisoning in the home, including regular hand washing, regular washing of children’s toys and pacifiers and regular cleaning of household surfaces; Drinking water, household paints (with the exception of houses that were built after 1978) and ceramics manufactured outside the United States / Europe should be tested for lead. Adults who are exposed to in the workplace lead dust should wear appropriate personal protective equipment, change before going home clothes and shoes and take a shower before going to bed. Summary houses that were painted before 1978 (especially if renovated or repainted), increase scattered ceramics (z. B. pitchers, cups, plates), which has a lead-based glaze, and certain occupational exposures, the risk of lead poisoning , Patients should be controlled by the determination of the Pb concentrations in the blood. The lead source must be eliminated (eg. As a gastrointestinal wash). A chelation therapy should be> 45 g / dl be prescribed for adults with PbB> 70 g / dl and for children with encephalopathy or PbB. It is DMPS (2,3-dimercapto 1-propanesulfonic acid sodium salt) 2l used for chelation therapy.

Health Life Media Team

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