Lead Poisoning

By Nabil A. Ebraheim, M.D. and Molly Ebraheim— Attorney at Williams DeClark Tuschman Co., L.P.A

Lead poisoning can occur when lead builds up within the body. This excessive amount of lead in the body can cause serious health problems. Children and adults can both experience lead poisoning, however, children are especially vulnerable and it can affect their mental and physical development.

Lead poisoning is a medical condition caused by increased levels of lead within the body that interferes with the normal physiologic processes of the body and is particularly toxic to children. This happens when lead and calcium (Figure 1) compete for protein that is important for body functions, especially the nervous system (Figure 2). Lead can displace the calcium consuming all the protein so that calcium will not be able to function properly.

How can we simplify the signs and symptoms of lead poisoning?

1. Lines in the gingiva and long bones. There will be a “lead line” in the gingiva (gums) called the Burton’s Line. The long bones will also have lead lines in the metaphysis that appear as white bands on an x-ray because the lead is collected within these white bands. The width and density of these lines reflect the depth of exposure.

2. The patient may also experience encephalopathy, as well as headache and memory loss.

3. There will be erythrocyte basophilic stippling of the cells because lead inhibits the ribosomal RNA degradation. The red blood cells will retain aggregates of ribosomal RNA that cause the stippling of cells, this suggests a toxic injury to the bone marrow (Figure 3).

4. Abdominal colic (pain, cramps, and constipation) and anemia. Lead inhibits the enzymes that are needed to make heme. This means that lead interferes with the production of hemoglobin.

5. Foot drop and wrist drop (Figure 4) is another condition that may occur due to lead poisoning. The patient may experience permanent damage to the central nervous system and the peripheral nerves.

Lead poisoning usually occurs from exposure to lead based paint, which is typically used in much older homes. Particles from the lead based paint are ingested through air or from contaminated drinking water. Lead contamination may occur due to bullet penetration of a joint or introduced into the cerebral spinal fluid. It may cause severe synovitis and low grade lead poisoning. Lead contaminating ground water may also contaminate the soil. Lead poisoning may then occur due to ingestion of food grown in this soil.

Exposure to lead for prolonged periods of time may cause serious health problems!

Children (Figure 5) are most vulnerable to lead poisoning, as it is very common for young children to put nonfood items into their mouths. This is why many children are tempted to eat paint chips. In some cases, children may have an eating disorder called Pica. Pica is a condition in which children have an obsession or compulsion to eat nonfood items. Between 1-6 years of age, 10-30% of children will develop Pica.

Children with lead poisoning will typically show signs of:

· Irritability

· Fatigue

· Lower IQ

· Lack of attentiveness

· The child may show signs of encephalopathy, nausea, vomiting, gait disturbances, and seizures.

Lead poisoning in adults is usually related to occupational exposure. Symptoms include:

· Personality changes

· Headaches

· Neuropathy

· Weakness

· Foot and wrist drop

· Stomach aches

Both children and adults will experience pale skin due to anemia because lead interferes with the normal formation of hemoglobin.

In order to diagnose lead poisoning, you will need to determine the history of exposure—the lead level is usually greater than 5 (some people use higher numbers), if a complete blood count (CBC) test is done, you will find microcytic anemia. Additionally, in a peripheral blood smear, you will find basophilic stippling of the ribosomes. The serum iron is normal.

In order to treat lead poisoning, you must first eliminate the source of the lead contamination. Then a chelating agent will be used. A chelating agent refers to the use of various drugs that help to remove the lead from the body. These drugs bind the lead into a form that the body can excrete. It is used if lead levels in the blood are high.

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