LEAD POISONING

It appears on high burden of lead on the body. It can be Acute and or Chronic (though symptoms appear acutely, poisoning is most often of chronic type).

In general population occurrence is through food and drinks (lead water pipes; tanks; food; beverages, stored in cans soldered with lead. Children chew lead based paints from old houses or broken weighted toys; also among those perusing hobby of painting glazing pottery, ceramics etc.)

In Industry – inhalation of contaminated air, fumes from vehicles using lead mixed petrol and so on.

Predominant ages 1 to 5 yrs. in children and adults Males = Females

Systems involved Endocrine/metabolic, Gastrointestinal and nervous system.

Signs and Symptoms a) Can be asymptomatic b) Acute inhalation – headache sleeplessness, ataxia, mania, convulsions, polyneuropathies usually involving extensor muscles.

Acute ingestion – Metallic taste in the mouth, thirst, heartburn, abdominal pain, abdominal guarding, blood diarrhea, renal damage, encephalopathy and CNS features including convulsions and coma.

Lead encephalopathy is more common among children specially those suffering from IRON DEFICIENCY ANAEMIA and (pica) dust from clothing of workers handling lead dust.

Differential Diagnosis – Poly neuropathies – Alimentary type can be confused with Acute Abdomen – Cerebral type may be confused with mental retardation, autism, dementia and other causes of seizures.

Investigation Asymptomatic person screened with erythrocyte protoporphyrin level > 35mg / dl Blood lead (Pb) more than 10mg / dl.

Management

Prompt removal from exposure. In severe cases supportive measures for seizures (diazepam). Cerebral oedema (Dexamethasone, mannitol) and Chelating therapy instituted in severe cases with blood lead level more than 100mg /dl Environment Health Officer must be informed for tracing the source of poisoning.

 

ASBESTOSIS

A form of PNEUMOCONISIS developing 15 to 25 or even more years after regular exposure to ASBESTOS DUST / FIBRES. (Mainly CHRYSOTILE – WHITE ASBESTOS)

AFFECTED PERSONS – Working in or in the vicinity where milling of the mineral; manufacturing processes involving ASBESTOS; demolishing work in ship – years – even people involved in accompanying works eg painters and electricians, joiners working in ship yards. SECONDARILY families of such workers also get involved.

Predominant age 40 to 75 years; males > females

SYSTEMS INVOLVED – mainly pulmonary a) Diffuse in interstitial fibrosis. b) Pleural Plaques c) Pleural effusion d) Mesothelioma of PLEURA & PERITONEUM e) INCREASED risk of lung Cancer and Tuberculosis among Smokers.

Signs & Symptoms – Chest discomfort, clubbing of nails, superficial crackles, exert ional dyspnoea, cyanosis, fatigue, malaise, non- productive cough, pleural effusion, pleuritic pain, pulmonary hypertension.

Note (HISTORY OF EXPOSURE TO ASBESTS DUST at least 10 years previously. Investigation A X-Ray Chest Lung Scanning B PULMANARY FUNCTIONS, SPIROMETERY AND DIFFUSION STUDIES C BRONCHOSCOPY AND LAVAGE D OXYMETERY

Once ASBESTOSIS has developed there is no effective Therapy. General measures include a) To provide relief of respiratory symptoms b) Avoid tobacco smoking c) Management of hypoxia d) Treat respiratory infection if there e) Combat airway obstruction if super added f) Malignancy surveillance and g) Management of cor-pulmonale

 

Brig. Dr. J. S. Bhalla

M.B.B.S., D.C.D., M.D., (Gen. Med), F.C.C.P., (USA) Fellow International Academy o Chest Physicians & Physicians & Surgeons (USA) Senior Consultant Tuberculosis / Chest Diseases SANTOKH NURSING HOME 846, SECTOR 38-A, Chandigarh (INDIA)