Lead poisoning
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Transcript of Lead poisoning
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Dr. Dalia El-ShafeiAss.Prof of Occupational
Medicine
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What is Lead?
Lead is a blush gray metallic element which occurs naturally (in small amounts) in the earth’s crust.
It is dense, hence its use as a ballast, ammunition, or radiation shield.
Lead is insoluble in water, but some salts are soluble.
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Lead is a soft, malleable poor metal. It is also countedas one of the heavy metals.It is sometimes found free innature, Although lead makesup only about 0.0013% of the earth's crust, it is not consideredto be a rare element since it is easily mined
and refined.
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What Is Plumbun?
Plumbing is derived from plumbun, Latin
for lead
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Significant Health Characteristics of Lead
Lead has a low melting point and can easily be aerosolized by heating.Lead can be formed into organic compounds by some organisms, and some organic compounds (such as “leaded gasoline”) have industrial uses.
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Lead poisoning is a medical condition caused by increased levels of the heavy metal lead in the body, and this can interfere with a variety of body processes and causes toxicity to many organs and tissues.
It’s also called plumbism, colica Pictonum or saturnism
What is lead poisoning???
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"Lead makes the mind give way."
Ancient Awareness
GreekDioscerides - 2nd BC
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LEADInlet to the body:
Through inhalation of dust & fumes. Also, ingestion & absorption through the skin (by organic compounds) may occur.
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How can the human be exposed to lead??
1 -Occupational exposure:- is the main cause of lead poisoning in
adults, as in lead miners and smelters, plumbers glass manufacturers,
construction workers …etc.
2 -Paints:- is the main cause of lead Poisoning in children. Many of the children display pica, so even a small
amount of a lead-containing product can contain hundreds of milligrams
of lead.
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3 -Soil:- is the main cause of lead poisoning in the agricultural areas.
By eating food grown in an contaminated soil.
4 -Water:- Lead from the soil oratmosphere can end up in surface water and groundwater. It is also potentially in drinking water.
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5 -Lead containing products -:Like plastic toys, bottles, cans……etc.
6 -Hunting:- Animals which are hunted are at high risk of exposure because of the bullets which may contain lead.
• Breast feeding is also considered as an important route of lead exposure because of the presence of the lead in the affected female milk.
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All children under the age of 6 years old. People living in old houses are at great
risk. People work in industries. Pregnant woman & developing baby.
Who is at high risk?
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Lead in Jewelry
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Lead in Environment
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Metabolism:A- Distribution in the body:- Bound to RBCs, membranes.- Precipitate in bone, teeth.- Exist in the plasma.B- Excretion:- Almost via the kidney.- Small amount excreted through bile.- Sweat and milk.
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What are the Normal levels of lead??
Adults:Less than 20 micrograms/dL of lead in the blood
Children:Less than 5 micrograms/dL of lead in the blood
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Agency Blood Lead Levels
60
40
3025
2015
10
20
10
20
30
40
50
60
Bloo
d Le
ad (u
g/dl
)
CDC1960
CDC1973
CDC1975
CDC1985
WHO1986
EPA1986
CDC1990
CDC2006?
Agency and Year
Acceptable Childhood Blood Lead Levels
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Prevention: By the triad of:a) Engineering control measures.b) Good industrial hygiene.c) Regular clinical examination and investigation.Treatment of lead poisoning:a) Identification of source of lead poisoning.b) Removal from exposure.c) Chelation therapy for symptomatic patient with blood lead level more than 100 microgram/ dl.d) Chelation is performed under strict medical supervision by giving the patient injections of calcium ethylene dianine tetra acetic acid (Ca EDTA) and/ or oral penicillamine.
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Occupational Exposure Levels
OSHA PEL 0.05 mg/m3, 8-h TWA
NIOSH REL 0.10 mg/m3, 10-h TWA;
ACGIH TLV 0.05 mg/m3, 8-h TWA
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Medical Surveillance for Adult Workers
When: Exposure above “action level” >30 days/yr
What: Triggers periodic exams & biologic monitoring (including blood level)
Removal threshold: 50 µg/dl (repeated) or 60 µg/dl once.
Repeat testing: Monthly, depending on lead level
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Adult Return to Work Lead poisoned workers can return to the
workplace when blood lead is <40 µg/dl. Symptomatic workers can remain out of
the workplace at lower levels. Workers whose blood lead is near 40 µg/dl
are most likely to be able to remain in the workplace if they can perform modified duty without lead exposure.
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The Key to “Treatment”of Lead Poisoning
Remove from exposure, or otherwise preventexposure.
Workplace Home Substitution MoveEngineering Identify and AbatePersonal ProtectionWork PracticesJob Placement
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Chelation
Not a decision to be taken lightly Requires close monitoring Inefficient process, typically reducing
body burden only 1 - 2 % Chelating agents may not significantly
reduce tissue levels, esp. in CNS
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Adult Chelation Therapy
Indicated for symptomatic Pb toxicity Generally less effective Never a substitute for control of exposure Unethical to give chelation for prophylaxis Indications for chelation depend on
symptoms and BPb (g/dl), not BPb alone
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C/P Blood Lead Level (µg/dl)
Chelation
Encephalopathy Any level BAL + EDTA“High dose”
Symptomatic > 100 BAL + EDTA“low dose”
Mild symptoms 70 -100 Succimer
Asymptomatic < 70 Medical removal
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