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Chronic Lead Poisoning এর ইতিবৃত্ত

SubhaJamilSubah Forensic Medicine, Platform Academia
Do you know about Lead Poisoning?

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

🔯 CVS

  • 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
Dysmenorrhea
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,
Encephalopathy.

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
→ CHD

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।

আমি-
🔯 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

Causes:

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

Features:

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।

রুহি-
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।

আমি-
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।

Reference:

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
2017-2018

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