|Drug Toxicity - clinical assessment
|Aspirin or Salicylates toxicity
|Ethylene glycol toxicity
|Carbon Tetrachloride Toxicity
|Renal Tubular Acidosis
|Tricyclic Antidepressant Toxicity
|Carbon monoxide Toxicity
|Paracetamol (Acetaminophen) toxicity
|Beta Blocker toxicity
|Calcium channel blockers toxicity
|Organophosphate (OP) Toxicity
|Toxin elimination by dialysis
|Drug Toxicity with Specific Antidotes
Prevention is best as a significant insult to the brain occurs at very low levels and that medical intervention with chelation fails to reverse such effects
- Lead is found throughout society and through many industries
- Lead acetate was once added to wine to make it sweeter.
- Lewis Carroll's mad hatter was possibly mad due to the lead used in his industry.
- Lead is often found in paint and so may be ingested by children who chew on lead-coated items.
- Over 95% of the Lead absorbed into the body is deposited in the bones and teeth
- Nausea, vomiting, Bluish line at gums
- Crampy abdominal pain - acute abdomen even
- Diarrhoea or constipation - a rare case in the Gastro clinic
- Nervous system
- Personality change, irritability, moodiness, poor memory, labile emotions, paranoid
- Looks like depression/mania/hypomania, Syncope
- Raised ICP and papilloedema, frank encephalopathy
- Ataxia, Cranial nerve palsies, Hallucinations, convulsions
- peripheral motor neuropathy - foot drop, wrist drop
- Renal system
- Renal tubular dysfunction and interstitial fibrosis
- Radiographs of the long bones in growing children may reveal Lead lines.
- These lines, actually growth arrest lines, are not pathognomonic but are associated with elevated lead levels over a protracted period of time.
- FBC and film: Hypochromic Anaemia, Punctate basophilic stippling and Haemolysis
- Urinary coproporphyrins are increased as lead blocks incorporation of iron into heme
- Risk of cognitive deficits increases when the whole blood lead level (PbB) is = 10 mg/dL (= 0.48 mmol/L) for an extended period, although the cutoff may be even lower.
- X-Ray of Knee or wrist shows lead lines dense metaphyseal bands
- Chelation agents are used - Sodium calcium edetate, BAL, DMSA and DMPS. Mild cases D Penicillamine can be given orally
- Lead is stored mainly within the bones and so repeated chelation may be needed as lead mobilises
- Treatment may not reverse CNS disease