Case of Lead Poisoning in 47-Year-Old

Lead poisoning

Lead poisoning with a 6-month history of wrist drop

A 47-year-old man with a 6-month history of wrist drop presented to the general care clinic. He also claimed a three-year history of abdominal pain and constipation, a 14-month history of disorientation, and a one-year history of tongue and gum darkening. He had been a manual labourer in a lead-acid car battery manufacturing for the previous 5 years. Physical examination revealed tongue hyperpigmentation (Panel A) and gingival ‘lead lines’ — bluish pigmentation along the gum line characteristic in lead poisoning patients with poor dental care (Panel B). On neurologic evaluation, there was evident wrist drop in both the arms (Panel C). Furthermore, with signs of decreased attention, working memory, and executive processing. Based on these findings the patient was diagnosed with lead poisoning.

The patient was advised further tests to confirm the diagnosis. Laboratory tests were consistent with microcytic anaemia, normal renal function, a normal manganese level, and a blood lead level of 83 g per deciliter (4.0 mol per litre; reference value, 10 g per deciliter [0.5 mol per litre]). A persistent lead poisoning diagnosis was made. Chelation therapy was begun. The patient was no longer employed at the factory, and the health care team was informed of the occupational exposure. The blood lead level was 32 g per deciliter (1.5 mol per litre) at a 6-month follow-up visit. Although the patient’s gastrointestinal and neurological symptoms had subsided, the mucosal hyperpigmentation remained.

What is lead poisoning?

Exposure to excessive quantities of lead causes lead poisoning. Lead is most typically found in homes constructed prior to 1978. Headaches, cramping, and hyperactivity are all signs of lead poisoning. A blood lead test can be used to identify lead toxicity. To prevent further exposure, treatment includes locating and removing the source of the lead. Lead is a toxic element that occurs naturally found in traces in the earth’s crust. It is a hazardous element that can have major health consequences for both humans and animals. Lead is particularly hazardous to infants and young children. It has the potential to harm them even before they are born.

The most prevalent source of lead is lead paint. Children who live in older homes where lead paint is peeling or homes with lead pipes are especially vulnerable.

Lead can also contaminate the following:

  • Herbal medicines or treatments.
  • Toys and candy from other countries.
  • Stained-glass windows.
  • Glassware with lead crystal.
  • Plates, pitchers, and cups made of glazed ceramics.

However, the use of lead paint has been banned in many countries including the United States.

Prior to then, lead paint was utilised both inside and outside of homes. Older paint often splits and peels. When it cracks, small bits of lead dust are released into the air. Sanding or scraping the walls of an ancient property in preparation for remodelling can also cause lead dust to be released. Lead dust settles on the ground and everything in its path. Children can be exposed to lead by putting things in their mouths or by touching lead-contaminated objects and then putting their hands in their mouths.Lead poisoning incidences have decreased since the ban on lead-based paint. However, it remains a serious public health concern in areas of the country where older homes are concentrated.

Although anyone can be poisoned by lead, newborns and children under the age of six are more vulnerable since their bodies are still developing. Their brains and nervous systems are more sensitive to the detrimental effects of lead since their bodies are still growing. Furthermore, newborns and young children are more likely to pick up objects and put them in their mouths. These items could be tainted with lead.

Source: NEJM

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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