Chronic Lead Poisoning এর ইতিবৃত্ত

গত ক্লাসে Chronic lead poisoning review করা হয়নি। তাই আজ Chronic lead poisoning পড়তে বসলাম।

রুহি- প্রথমে বল তো, Sign-symptoms of chronic lead poisoning কি কি আছে?

আমি- 🔴 Signs-symptoms of chronic lead poisoning

🔯 General symptoms

  • Pallor
  • Weight loss
  • Anorexia
  • Abdominal colic relieved by pressure
  • Constipation
  • Blue line (Burtonian line) on the gum


  • Vasoconstriction
  • HTN
  • Rarely hypertensive encephalopathy

🔯 Loco-motor

  • Muscle weakness
  • Wrist drop.
Figure: Signs & Symptoms of Chronic Lead Poisoning

🔯 Blood

  • Hypochromic anaemia
  • Punctate basophilia

🔯 Renal

  • Albuminuria
  • Chronic interstitial nephritis

🔯 Reproductive

  • Menstrual derangement
  • Miscarriage
  • Still birth
  • Sterility

রুহি- আচ্ছা বল তো, Menstrual derangement বলতে কি কি বুঝায়?”

আমি- Amenorrhea
Menorhagia etc.
এখন তুই বল, Treatment কি কি হতে পারে?

রুহি- 🔴 Treatment of chronic lead poisoning:

  1. Remove the patient from the source of poison ( Blood level of 0.007 mg/dl is dangerous, needs hospitalization ).
  2. Chelating agents are used to remove lead from tissue either by EDTA or penicillamine. 750- 1500 mg/day.
  3. DMSA (Dimercaprosuccinic acid), DMPS (2,3- Dimercaptopnopure 1-salphonate).
  4. KI or Nal in medicinal doses.
  5. NaHCO, 20-30 gm/day.
  6. Calcium gluconate 20% solution 15 ml or Calcium chloride 10% solution 10 ml.
  7. Saline purgatives- MgSO4 to remove lead from bowel.
  8. In encephalopathy- Diagnostic lumbar puncture. Inj. Mannitol for increased intracerebral pressure.
  9. Improve general health by high protein diet, calcium, ample of food.

আমি- আচ্ছা। আর Cause of death কি কি হতে পারে?

রুহি- Malnutrition,
Intercurrent infection,
Liver failure,
Renal failure,
Respiratory failure,

বলতো Post mortem findings কি কি পেতে পারি?

আমি- Post-mortem findings in chronic lead poisoning

➡ External findings

  • Baby is emaciated.
  • A black line along the margin of gum.
  • The paralyzed muscles see flaccid & show fatty degeneration.

➡ Internal findings

1) Intestines: Contracted & thickened.

2) Kidneys-

  • → Small & contracted.
  • → Evidence of tubular necrosis with intra nuclear inclusion bodies.

3) Liver: Hard & contracted.

4) Heart: Left ventricular hypertrophy.

5) Brain: Oedematous, herniation & sign of
compression may be present.

Chronic and acute lead poisoning তো জানা হলো।
তবে এবার জানা যাক Lead poisoning এর Complications গুলো।

রুহি- 🔴 Complications of lead poisoning:

1) Renal system:
→ Nephropathy
→ Fanconi syndrome

2) CVS: → HTN

3) CNS: → Stroke

4) Reproductive system
🔯 Male
→ Oligospermia
→ Abnormality in motility & morphology of sperm

🔯 Female:
→ Miscarriage
→ Prematurity
→ Low birth weight

আমি- বাচ্চাদের জন্য কেমন ক্ষতিকর এটি?

রুহি- Lead is more harmful to children as it can affect developing nerves & brain.

🔯 Additional complications for children-
↓ Loss of developmental skills,
↓ Behavior attention problems
↓ Hearing loss
↓ Kidney damage
↓ Reduced IQ
↓ Slow body growth

বল তো Lead এর আরেক নাম কি?

আমি- Plumbum।

রুহি- হু, এই Plumbum শব্দ থেকেই এসেছে Plumbism এবার Plumbism নিয়ে বিস্তারিত বল।

🔯 Plumbism– Chronic lead poisoning is known as plumbism.

1) Plumbism is more common among the painter, printer, plumbers, potters & workers in lead factories.

2) Plumbism may result from canned food contaminated with lead.

3) Drinking water & from constant use of hair dye & cosmetics containing lead.

Figure: Sources of Lead Poisoning

4) Hindu married women are in the habit of applying vermilion over the part of scalp hair above the middle forehead & lead is absorbed from it.

5) From air pollution by exhaust of petrol products.

বল তো Plumbism এর অপর নাম কি?

রুহি- Saturnism।

আমি- Correct। এখানে Bells palsy এর মতো পাওয়া যায় Lead palsy। জেনে নিই Lead palsy সম্পর্কে।

Lead palsy– It is a specific feature in case of chronic lead poisoning


It occurs due to degeneration of nerves & atrophy of muscles which may be the result with the phosphorus-creatinine metabolism at the muscular level.


1) Initially
→ Numbness
→ Hyperesthesia
→ Fibrillation
→ Tremor
→ Cramps

2) Finally- Wrist drop & foot drop due to paralysis of extensor muscles of wrist & of anterior tibial muscles respectively.

3) There may also be paralysis of deltoid, biceps, ocular muscles & intrinsic muscles of the fingers & toes.

এখন বাকি রইলো Lead line। Definition of lead line বল তো দেখি।

Lead line– It is a stippled blue line on the gums especially on upper jaw, due to epithelial deposit of lead granules.

Figure: Lead Line

বল তো একে আর কি কি নামে বলা হয়?

আমি – Blue line/ Burtonian line।

রুহি- বল তো কোন কোন Poisoning এ এই Lead line পাওয়া সম্ভব।

Lead line is found in the following cases of poisoning-
1) Lead
2) Mercury
3) Copper
4) Bismuth
5) Iron
6) Silver
এবার জেনে নিই Mechanism of lead line।

রুহি- তাহলে এইবার বলি mechanism of lead line
🔯 Mechanism
Decomposition of food in the mouth

Formation of HS

HS + Lead

Lead sulphide

আচ্ছা বল তো Recovery of lead poisoning possible?

আমি- Yes, possible but rare.

রুহি- তাহলে আজ এখানেই শেষ!
প্রস্তুত তো আইটেম দেয়ার জন্য?

আমি- অবশ্যই।


Dr.K.S.Narayan Reddy & DR.O.P.Murty, The essential of forensic medicine and toxicology, 33rd edition.
DR.Apurba Nandy, Principles of forensic medicine including toxicology, 3rd edition.

Platform Academia/
Monadia chowdhury
Southern medical college

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