Lead Poisoning

Sources: • Occupational: lead smelting, battery manufacture, soldering, painting, plumbing. • Domestic: old paint (pre-1980), lead pipes, contaminated water, traditional remedies (Greta, Azarcon, Surma, Kohl, Indian / Asian remedies), some pottery glazes, contaminated soil, retained bullets. • Children: PICA, paint chips, contaminated dirt. Features: Acute: • Abdominal pain (lead colic), vomiting. • Encephalopathy in severe (children > adults): seizures, coma — emergency. Chronic: • Anaemia (microcytic, basophilic stippling). • Peripheral neuropathy (motor, especially radial = wrist drop). • Renal impairment (chronic; tubular). • Hypertension. • Decreased fertility. • Cognitive impairment (children — irreversible). • Constipation. • Lead lines on gums (Burton's line). Workup: • Blood lead level (whole blood; >5 micrograms/dL elevated; >70 micrograms/dL urgent). • FBC + film (microcytic anaemia + basophilic stippling). • U&E, LFTs. • Urinary lead. • Erythrocyte protoporphyrin / zinc protoporphyrin (raised in lead exposure). • AXR (radio-opaque flecks if recent ingestion). • Long bone XR in children (lead lines).