Lead poisoning

FACTS

Anemia types vs. metabolic conditions
Microcytic anemia
Macroyctic anemia
Iron deficiency
lead exposure
folate deficiency
etoh use disorder
copper deficiency

HPI

  • Sensory-sparing peripheral neuropathy
  • lead encephalopathy

Labs: microcytic anemia

PHYSICAL EXAM

universal neuro exam
  • isolated wrist and finger extensor weakness (usually bilateral, adults > children)
  • foot drop (usually children)

IMAGING

 
A/P
  • remove exposure
  • hydration / nutrition (Fe2+, Ca2+, vitamin C) → ↓ lead absorption
  • Chelation therapy guided by BLL and symptoms:
    • <45 µg/dL: none
    • 45–69 µg/dL: PO DMSA (succimer)
    • ≥70 µg/dL or symptomatic: IV EDTA (calcium disodium edetate) ± dimercaprol (British anti-Lewisite, BAL)