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ACUTE EXPOSURE INFORMATION
- USES: Lead is a soft metal that is used in a variety of industrial processes. It has been used in paint and gasoline, but the use of lead in house paint and gasoline has been outlawed for decades in the United States (US). Folk medications may also contain large amounts of lead salts. Soil may have large amounts of lead contamination from industrial processes or old paint. Some products manufactured outside the US (eg, pottery, jewelry, toys, makeup) may contain lead.
- TOXICOLOGY: Lead exerts its toxic effects through a variety of mechanisms and effects many organ systems. It binds sulfhydryl groups, impacting various enzymes, receptors and proteins. Lead interferes with metabolic pathways in mitochondria, and in systems that regulate cellular energy and metabolism. It causes activation/inactivation of many enzymes via its competing effects with other cations, notably calcium, ferrous iron, and zinc. Lead inhibits several enzymes involved in heme synthesis, and impairs erythrocyte membrane stability, causing anemia.
- EPIDEMIOLOGY: There are several thousand cases of lead poisoning reported to poison centers in the US every year. However, severe toxicity is very uncommon and deaths are rare. In children with chronic lead poisoning, ingestion of lead paint chips and dust in older dilapidated housing is the most common source of exposure. Inhalational exposure is the most common cause of adult/occupational lead toxicity.
- WITH POISONING/EXPOSURE
- MILD TO MODERATE TOXICITY: The primary concerns of mild to moderate toxicity from lead exposure in young children are neurodevelopmental, specifically lower intelligence quotient scores and behavioral problems. Population studies suggest that mild cognitive impairment develops at low levels of lead exposure (blood lead concentrations of 10 mcg/dL). Intermittent vomiting, anorexia and abdominal pain may also develop. In mild to moderate exposures in adults, concerns include hypertension, spontaneous abortion and sperm abnormalities, and more subtle neurocognitive effects. Fatigue, mild somnolence, headache, insomnia, abdominal pain, constipation, mild anemia, myalgias and arthralgias, and mild weakness may also develop.
- SEVERE TOXICITY: Acute ingestions of very large amounts of lead are rare, but may cause abdominal pain, nausea, vomiting, anemia (usually hemolytic), toxic hepatitis, and encephalopathy. In children, severe toxicity manifests as encephalopathy (ie, coma, seizures, ataxia, incoordination, cranial nerve palsies, increased intracranial pressure, bizarre behavior or altered mentation), persistent vomiting, and anemia. More severe subacute or chronic exposures in adults can lead to symptoms such as fatigue, malaise, irritability, anorexia, insomnia, weight loss, decreased libido, arthralgias, myalgias, hypertension, crampy abdominal pain, nausea, constipation or diarrhea (less commonly), impaired concentration, headache, diminished visual-motor coordination, tremor, encephalopathy, a peripheral motor neuropathy (especially affecting the upper extremities causing wrist drops), a normochromatic or microcytic anemia (the hallmark of which is basophilic stippling), nephrotoxicity (a reversible acute tubular dysfunction and chronic interstitial fibrosis), hyperuricemia, and associated gout.
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