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62 Cards in this Set
- Front
- Back
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What are some of the heavy metals we need o worry about in our environment?
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Pb, Hg, Cd, Ni
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How can we get exposed to heavy metals in general?
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1. Erosion of rocks from rain
2. Transported in rivers to oceans 3. Disbursed by rain 4. Bioconcentrated in plants and animals (food chain) 5. Industrial activities |
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Lead poisoning is called ______.
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plumbism
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Pb goes ______ in the body. It impairs normal ______ ______, and bonds with ______ ______.
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everywhere
cell functions cell ligands |
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Lead is ______ in the environment and was the reason for the fall of the ______ ______.
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ubiquitous
Roman Empire |
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Name some sources of lead.
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Soil, dust, stained glass, plumbing, solder, glazed pottery, lead vessels, antiques, gasoline, paint, candle wicks.
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Name some ethnic/traditional remedies that have lead.
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greta, azarcon, rueda, litargirio
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Sugar of lead is ______ ______.
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lead acetate
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______ is an eating disorder that involves eating non-food items. (Like paint chips)
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PICA
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______ are more susceptible to lead poisoning than adults.
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Kids
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Lead gets absorbed through the ______ and the ______ systems.
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GI
Respiratory |
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Absorption of lead by mouth is _____% for adults and ______% to ______% for children
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10%
40% TO 50% |
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When lead is absorbed in the GI, it competes with ______ and ______.
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Ca2+
Fe2+ |
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Lead when inhaled is absorbed at ______%.
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90%
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The half life of lead in the blood is ______, at steady state it is ______, and in the bone it is ______.
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1-2 months
6 months 20-30 years |
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Describe ADME of lead.
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1. Initially Pb gets bound to Hb in blood.
2. Then it distributes to the soft tissues. Especially tubular epithelium 3. Redistributes slowly into bone, teeth, nails, and hair. 4. Eventually 90% end up in the bone. 5. Excretion is mainly through urine, but also some in the bile. |
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______ lead is the lead found in fuel, prior to unleaded fuel. It quickly distribures into the ______.
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Tetraethyl
CNS |
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Pb resembles ______ in terms of bone deposition.
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Calcium
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When there is high calcium and vitamin D with adequate ______, ______ is favored over _____ to be deposited into the bone.
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phosphate
lead calcium |
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When there is ______ ______, ______ is favored over ______ to be deposited into the bone.
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low phosphate
calcium lead |
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When calciu is favored over lead to deposit into the bone, lead will deposit into ______ ______.
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soft tissue
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Which is more dangerous? Lead in the soft tissue, or lead in the bone?
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lead in the soft tissue. It is available for advere effects. You are pretty safe when it is in the bone, unless you have a bone problem.
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One way to diagnose lead is by looking at ______ ______ in the bone. These are left by deposits of lead as the bone ______.
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lead lines
grows |
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______ ______ is the amount of lead in ones body.
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body burden
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______ ______ is when lead intake matches lead output, approximately ______.
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lead balance
0.2mg/day |
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The body burden ______ ______ ______.
______ is called a slow accumulation of lead. One would show NO signs of lead poisoning. An intake higher than ______ would cause a toxic accumulation. |
grows with age
0.6mg/day 0.6mg/day |
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______ lead poisoning is very rare and it typically effects the ______ and the ______.
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acute
GI kidneys |
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______ lead poisoning can effect.....
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chronic
GI Neuromuscular CNS Hematological Renal Other |
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What are the symptoms of GI lead poisoning?
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Metallic taste
Constipation or Diarrhea Lead Colic (severe abdominal pain) |
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What are the symptoms of Neuromuscular lead poisoning?
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Lead Palsey (Sometimes called Painters Palsey), which is:
muscle weakness fatigue wrist-drop foot-drop |
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Lead poisoning the CNS can cause ______ ______. Blood levels are usually around ______,
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lead encephalopathy
100 micrograms/dL |
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Children can have ______ or ______ lead encephalopathy.
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acute
chronic |
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What are the symptoms of acute encephalopathy?
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delerium
convulsions paralysis coma death sudden onset with possible repeat episodes |
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What are the symptoms of chronic encephalopathy?
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vertigo, falling, restless, irritable, headache, ataxia, decreased attention span, hallucinations, memory loss
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Lead can cross the _____ and cause ______, and ______ deficits that manifest later.
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placenta
intellect behavioral |
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With lead blood levels at ______ there can be a ______ point IQ decrement in preschool which translates to a ______ point deficit at age 8. This is related to ______ ______ episodes and the more episodes one has the more ______.
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40 micrograms/dL
5 3 acute encephalopathy impairment |
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What are the two hematological conditions that arise from lead poisoning?
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Hypochromatic microcytic anemia
Basophilic Stippling |
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What is hypochromatic microcytic anemia?
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It looks like iron deficiency in a blood smear.
It shortens RBC lifespan Inhibits heme synthesis |
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What is basophilic stippling?
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It is an aggregation of RNA in the RBCs
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hypochromatic microcytic anemia and basophilic stippling, when seen in blood can be used to ______ lead poisoning.
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diagnose
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Heme is made from ______ and ______.
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succinyl CoA
glycine Fe (later in the process) |
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Lead inhibits ______ and can inhibit ______.
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d-ALA dehydratase
Ferrochelatase (Fe attachment) |
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With lead poisoning the blood makeup changes. What can be seen when lead inhibits certain enzymes?
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Amount of:
Urinary d-ALA increases Heme decreases Free Fe increases Protoporphyrin IX increases Other porphyrins or derivatives increase Look at slide 220 |
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Lead poisoning that effects renal system can be _____ or ______. The _____ poisoning is ______ and the _____ poisoning is usually from long-term ______ exposure.
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acute
chronic acute, reversible chronic, industrial |
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With renal lead poisoning a ______-______ complex forms called ______ ______ bodies.
Also, with renal lead poisoning a ______-like syndrome can occur. The signs are.... |
lead-protein complex
nuclear inclusion Fanconi Proteinuria, hematuria, casts in urine |
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Some of the "other" effects of lead poisoning include....
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Decreased sperm count
Premature aging Weakness, emaciation Lead-line in gums (blue-black) Cacinogenicity? (maybe) |
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What are some ways to diagnose lead poisoning?
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First, know that the signs and symptoms of lead poisoning are similar to other heavy metals
Urinary d-ALA, pyrroles RBC protoporphyrin Blood lead level greater than or equal to 10 micrograms/dL |
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What are the key blood levels of lead?
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less than 9 (no lead poisoning)
10-19 (community prevention) 20-44 (consider chelation) 45-69 (medical and environmental intervention) 70+ (Medical emergency) |
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The CDC has universal screening of lead for children at ______ of age. At a blood level of _____ an environmental cleanup is necessary. At a blood level of ________, we should consider chelation therapy.
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6 months
10 micrograms/dL 25 micrograms/dL |
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Heavy metal ______ are used to reverse the binding of heavy metals. This is called ______.
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antagonists
chelation |
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Heavy metal antagonists compete with ______ ______ for metals, they form a ______ with the metals and they prevent and reverse ______ to cell ligands.
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cell ligands
complex binding |
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______ is a terrific new chelator. It can be taken by ______, it is excreted via the ______ and the ______, and importantly, it DOES NOT mobilize the ______ metals like (Zn, Cu, and Fe). It is also the ______ toxic chelator.
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Succimer (2,3 dimercaptosuccinic acid)
mouth kidneys, bile essential least |
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______ ______ ______ is _______. It is taken IV or IM; however IM is very painful. This is the only chelator proven to improve ______. It needs to be infused ______ to avoid ______ ______.
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Calcium disodium EDTA
IQ slowly acute encephalopathy |
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Be careful of using ______ ______ instead of ______ ______ ______ by mistake. It will cause ______ ______.
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disodium EDTA
calcium disodium EDTA FATAL hypocalcemia |
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_____, otherwise known as ______ is used for Hg, As, Cd.
It has an ______ ____, can not be taken ______, it requires a deep _____ route and therefore is very painful. |
BAL, Dimercaprol
offensice odor |
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_____ can cause hemolysis in G6PD patients and BP may increase by 50mm Hg then return in 2 hours.
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BAL or Dimercaprol
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______ is a chelator that can be taken ______ on an empty ______.
_______ is a ______ that is used for Pb, Hg, As. and Cu. |
D-penicillamine
orally, stomach dimethylcysteine, D-penicillamine |
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_______ is a chelator that is used for ______ toxicity. Also used for _____ for people on dialysis. It also has a very low affinity for ______. It is poorly absorbed _____. It is given _____ or _____ instead.
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Deferroxamine
Fe Al Ca PO, IV, IM |
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The dose of Succimer is?
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10 mg/kg q8h X 5d the q12h X 2 weeks
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The dose of Edetate is?
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25-50mg/kg daily X 5d
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The dose of dimethylcysteine is?
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1-1.5g daily divided into 4 doses X 2-5 days
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The dose of Deferroxamine is?
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10-15 mg/kg/hr IV
50 mg/kg IM |
