Poisoning - Lead Exposure

Victoria Samonte
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Clinical Presentation of Lead Poisoning
The symptoms of lead poisoning in children were first reported in 1892 in Australia. To date, research and interest in lead poisoning has increased, particularly with regards to its varied yet non-specific clinical presentations, especially in children. The effects of lead toxicity are recognized to be multi-systemic. In children, the organ systems that are more commonly adversely affected are the central nervous system and the hematopoietic or hematologic system. Lead is known to be absorbed through the gastrointestinal tract by ingestion, through the lungs by inhalation, and through the skin by surface contact. Absorption through the intestinal tract by oral ingestion is the predominant and more common route for the pediatric population, especially for young children (1-6 years) and children or individuals with developmental challenges, who demonstrate and exhibit hand-to-mouth behavior and in who risk of exposure to lead is higher. Rates of gut absorption are also dependent on the nutritional status of the individual. Lead absorption through the intestinal tract increases when dietary intake of iron, calcium, phosphorus, or zinc is low.
Neurologic and Neurodevelopmental Findings and Symptoms of Lead Poisoning in Children
The developing nervous system in the pediatric population makes it more sensitive and susceptible to lead-induced damage and injury. Early and more common non-specific neurologic symptoms of lead exposure and poisoning in children are headache, irritability and labile mood, behavioral changes, hyperactivity or decreased activity, delay or loss of developmental milestones, hearing and speech problems, and poor attention span. More significant exposure to lead may cause symptoms in children that are more likely to lead to a medical evaluation, such as headache, ataxia, somnolence, signs indicative of increased intracranial pressure and intracranial hypertension, lethargy, seizures, status epilepticus, stupor, and even coma.
Hematologic Findings and Symptoms of Lead Poisoning in Children
There are 3 well-recognized deleterious effects of lead on the hematologic and hematopoietic systems of children: 1) disruption of heme synthesis; 2) reduction of circulating levels of hemoglobin; and 3) microcytic hypochromic anemia. These 3 adverse effects result from the disruption and inhibition of the hematopoietic processes by lead.
Lead poisoning has neither pathognomonic symptoms nor typical clinical findings. When symptoms do occur, they are usually nonspecific. It would be prudent to consider lead poisoning whenever a small child presents with peculiar symptoms that do not match any particular disease entity.


References
Poisoning - Lead Exposure Poisoning - Lead Exposure 05/11/2016
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