HEAVY METAL POISONING

Bernardina B.Regner,M.D.,FPAFP,FPSECP,PCOM
• Objectives:
• 1.Know the general principles related to heavy
metal poisoning.2.List the common sources of
heavy metal exposure and describe their
mechanisms of action and their toxicities.
• 2.List the common sources of heavy metal
exposure and describe their mechanisms of
action.
• CASE
• A mother brings her 6yo son in for checkup
• He had progressive difficulty walking in the past few
months and has seemed irritable.He has also seemed
quite tired.He has vomited on one or two
occasions.His past medical history is
unremarkable.He was born after an uncomplicated
full term pregnancy.He has had all of his vaccines and
had achieved all of his developmental milestones of
his age.He lives with
• His parents in a home full that was built in the
1920s,while they have been renovating.On
examination,he is somewhat restless but
cooperative.His conjunctiva and mcous
membranea are pale.Neurologic exam is signi-
ficant for an ataxic gait(clumsiness).His general
examination is otherwise unremarkable.A
complete blood count(CBC) shows him to be
anemic.A serum lead level
• Is markedly elevated.You admit him to the
hospital and start him on succimer.
• Questions:
• 1.How does chronic lead exposure cause
anemia?
• 2.What is the mechanism of action of
succimer?
• CLINICAL CORRELATION:Most lead toxicity
• In children is a result of GIT ingestion.Children
absorb a greater portion of ingested lead than
adults do.The source of this lead is often from
lead-based paint that was widely used before
the 1970s.Inorganic lead binds to hemoglobin
and distributes to soft tissues,including the
brain.It later accumulates in the bone,from
which it is eliminated slowly.Lead produces
anemia via the inhibition of the enzyme
• &aminolevulinic acid to porphobilinogen.This
interrupts the pathway of synthesis of hemo-
globin.Lead can also cause central nervous
• system(CNS) effects,especially in children.
• Common signs include
vertigo,ataxia,headache,restlessness,and irri-
tability.Vomiting,delirium,and seizures may
occur.Lowered IQ and behavioral disturbances
• may be the result of childhood exposure.Treatment
of lead toxicity requires cessation of exposure and
in severe cases,chelation therapy.In
children,succimer is frequently used.It can be
administered orally.It binds to lead and increases
the excre-tion of lead in the urine.Other drugs used
for chelation include calcium disodium
ethylenediaminetetraaceticacid(EDTA),dimer-
caprol and penicillamine.