Heavy Metal Poisoning

1. Lead Poisoning

Occupational toxin.

Clinical Features of Heavy Metal Poisoning

Severe toxicity. Blood lead levels >60–80 mcg/dL (adults): gastrointestinal distress, nausea, and vomiting; >80 mcg/dL: encephalopathy. Acute lead nephropathy: condition similar to Fanconi

Chronic poisoning, GI distress; anemia (basophilic stippling);
Lead poisoning precipitated saturnine gout; Nephrotoxicity (proximal tubular damage, interstitial fibrosis); Peripheral motor neuropathy (wrist drop > foot drop). The line of Bruce. A pale line on the gingiva.

Lead line on X-ray (deposition of calcium in metaphysis).

Diagnosis Of Lead Poisoning 

Blood lead levels (over 45 in kids and above 80 in adults)
The amounts of erythrocyte zinc protoporphyrin, blood d-ALA dehydratase, and lead line.

Cortical bone lead levels, basophilic stippling.

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Treatment Of Lead Poisoning

Acute poisoning; supportive care; chelation; chronic; vitamin C (interferes with absorption of lead); iron and calcium.

Chelation Therapy

Indications: Lead concentrations >45 mcg/dL in kids; >80 mcg/dL in adults; DMSA; Simplimer; Dimercaprol; British anti-Levicide (BAL); D-penicillamine; Not FDA authorized.
used in the illness Wilson.

Q. Which of the following is the preferred chelating agent for managing a patient who has lead-induced encephalopathy?

Dimercaprol

Q. Which of the following routes of exposure to elemental mercury carries highest risk of acute toxicity?

Inhalation

2. Mercury Poisoning   

Mercury

• Elemental Mercury(vaporizable), 
• Methyl mercury 
• Mercury salts 

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Acute Mercury Poisoning 

Inhalation (basic): ARDS, sickness resembling Kawasaki disease .  Ingestion (inorganic): corrosive; can result in renal failure, ARDS, esophagitis, and gastritis; systemic shock.

Chronic toxicity

Inhaled, Danbury tremor: Cerebellar signs: Hatter's shakes, ataxia, reeling gait,  Mercuria lentis; inorganic mercury ingestion; colitis, melanosis coli, renal injury; Acrodynia (painful erythema), commonly known as pink disease; Erethism (mad hatter) - a neuropsychiatric condition.

Methyl mercury poisoning caused by organic mercury .  Minimata disease (dysarthria, ataxia, coma > death, visual and hearing loss, tremors) , observed in brain lesions.  Originated from fish tainted with industrial contaminants; reported from Japan.

Diagnosis 

• Blood mercury levels: used to treat acute poisoning; normal <10 mcg/L.
• Urine mercury: normal <50 mcg/L; used to treat long-term toxicity.

Q. Which is the best specimen for diagnosis of mercury poisoning in the following settings?

Methyl Mercury Poisoning- Chronic

Acute poisoning

Mercury interacts with sulfhydryl groups during decontamination, supportive care, gastric lavage with milk or egg, and other processes.

Chronic Toxicity: chelation (DMSA, DMPS, BAL, D-penicillamine)

Q. Which of the following chelating agent is not useful for management of methylmercury poisoning?

Ans. DMSA

 3. Aluminium  Phosphide Poisoning

Death rate of 100%, Phoxine is a toxic metabolite. When water or HCL come into touch with aluminum phosphate. The release of phosphone gas, leaving behind aluminum chloride or hydroxide.

Phosphine is a cell poison;  Cyt C oxidase inhibition. Superoxide dismutase is induced.,  catalase is inhibited., depletes reserves of glutathione.  A rise in damage from free radicals.  Paralysis of the breathing.  Causes the demise of cells.

Clinical Manifestation

Shock, As a result of shock and increased lactic acid generation; severe metabolic acidosis; myocardial depression; arrhythmias (ST-T alterations).

Diagnosis Of ALP Poisoning

Triadic symptoms include: metabolic acidosis; garlicky smell (OP poisoning); hypotension; breath; gastric aspirate; GC-NPD; gas chromatography-nitrogen and phosphate detector; and most sensitive and specific.

Management Of ALP Poisoning

Assistance with care.  Magnesium sulfate ,  NMDA receptor inhibition.
Lower the incidence of arrhythmia (does not lower mortality) .  Reduce the formation and absorption of phosphine gas in coconut oil and other fat-rich products.

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