Lead Poisoning

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What is Plumbism?

Plumbism is the medical term for lead poisoning. The Center for Disease Control and Prevention (CDC) in the United States considers childhood plumbism present when the PbB (lead blood level) is equal or greater than 10 microgram per deciliter, at which level cognitive deficits may start to manifest.

What are the common sources of lead poisoning?

The high-doze exposure includes swallowing pain chips among infants, young children, and mental patients; using lead glasses or kitchen wares; inhalation of leaded gasoline fumes; metallic lead objects (fishing weights, pellets, shots, curtain eights, etc) in the stomach or joint spaces; burning lead-painted wood and inhaling the smoke; taking folk medicines containing lead; eating acidic foods and drinks stored in improperly lead-glazed ceramic wares; ingestion of lead-contaminated wine or whiskey; and, exposure to lead without protection in the workplace. The low-dose source is from lead-contaminated dust and soil on items at home like miniblinds.

What are the signs and symptoms of plumbism?

Depending on the degree of exposure to lead, plumbism may take a while to occur. This could be associated with recurrent episodes of acute symptoms, which may have detrimental effects on the patient, like cognitive deficits in children and damage to the brain and kidneys in adults. When the blood concentration of lead is greater than 50 to 100 microgram/deciliter, the danger of symptomatic lead poisoning goes up. If the level is 100 mcg/dL or more, the risk of brain damage is greatly increased.

How does the condition present itself?

The onset of symptoms among young children is usually abrupt, within one to five days, ushered in by continuous and forceful vomiting, seizures, changes in consciousness, unstable gait, which could end in coma. These are all due to cerebral edema (swelling of the brain). Several weeks before these symptoms, the child may show reduced play activity and irritability. Sometimes, the condition may be mistaken for meningitis, acute encephalitis, brain tumor or brain abscess (infection with a pocket of pus in the brain).

How about in older children?

In older children, it could present as mental retardation, seizure disorders, aggression and developmental regression. Anemia in plumbism cases at any age group may be present, due to the lead and also to iron deficiency. Psychosis may also be present if tetraethyl or tetramethyl lead is involved.

And among adults?

Among adults, the typical sequence of signs occur over several weeks, with headaches, changes in personality, poor appetite, abdominal cramps and colic, metallic taste in the mouth, constipation, and vomiting. Encephalopathy is uncommon.

Who could be exposed to lead?

The following environmental situations contribute to lead exposure: Those who live in houses built before 1960, with peeling paint, and those who visit these houses often; this could be day-care centers, pre-school buildings, or the home of a baby-sitter. Adults whose work or hobby involves lead, and people close to them; those in houses built before 1960 which are being renovated; those who live close to battery recycling plants, active lead smelter, and other industry that release lead fumes to the environment; those who have family members or playmates who are being treated for lead poisoning; and those who eat fish and other item from waters contaminated with lead, discharged as waste products of some irresponsible industrial companies.

Do bullets lodged in the body caused plumbism?

Lead bullets in the body do not cause lead poisoning. The body encapsulates all foreign bodies with scar like tissues, as a natural protective mechanism, which would prevent any significant amount of lead from getting into the blood.

Can biting on pencils and crayons cause lead poisoning?

Yes, if there was lead in the paint or coloring material used in them. This used to be a great and common sources of lead exposure for children, until the government enacted laws that prohibit the use of leaded paints and other coloring materials. Today, you hardly see any leaded paints anymore. There is also a move to phase out leaded gasoline in most countries to protect the global environment.

Are canned goods a source of lead?

The cans used for foods and beverages are made of aluminum. In spite of this, however, it is prudent to empty canned goods into a glassware and not store them in cans for more than a couple of hours.

How about water through lead pipes?

Yes, this is a possible source of lead, especially when the water that goes through them is warm or hot. Lead pipes have also been replaced by copper, galvanized iron, or polyethylene aluminum, and other materials.

What is the treatment for plumbism?

The treatment for lead poisoning is called chelation therapy. While some unscrupulous medical practitioners still claim and administer chelation therapy (for $4000-$5,000) "to wash away and get rid of cholesterol deposits and dissolve hardening of the arteries as a treatment for coronary heart disease," (which are unfounded claims, and the use of which for that purpose is totally useless and is criminal), this therapy is most effective for metal poisoning, like plumbism.

When is chelation therapy started?

This treatment is initiated only after the source of the lead exposure has been removed. Among acute symptomatic patients, with presumptive diagnosis made, the chelation is given even before the blood and urine test results are in, to avoid unnecessary delay.

What are the contraindications of chelation?

Those patients who do not have symptoms, and those with concurrent kidney or liver disease should not receive chelation treatment.

Any adjuvant therapy?

Yes, for those severe lead poisoning (Class IV and V), chelation is combined with dimecaprol (BAL) and CaNa2EDTA treatment, as long as good urine flow is present. The maximum duration of treatment is 5 days to avoid depleting the body of other essential metals, like zinc.

Can these be used to prevent lead poisoning?

No, none of these drugs are recommended for prophylaxis against lead poisoning. Besides their potential adverse side effects, it does not make medical sense to use them while being continually exposed to lead. The best way to prevent plumbism is to avoid exposure to lead.

©2003Raoul R. Diez, M.A.O.D.