Lead poisoning physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D.
Overview
Patients with chronic lead poisoning usually appear very sick. Physical examination of patients with lead poisoning is usually remarkable for neurological[1], gastrointestinal[2], and hematological problems.[3]
Physical Examination
- Physical examination of patients with lead poisoning is usually remarkable for:
Appearance of the Patient
- Patients with lead poisoning usually appear normal.
Vital Signs
- Tachycardia with regular pulse might be present due to anemia
Skin
- Skin examination of patients with lead poisoning is usually normal.
HEENT
- Abnormalities of the head may include: [3][4]
- Burton's lines[5]
- Icteric sclera
- Headache
- Metallic taste
- Irritability
- Insomnia
- excess lethargy
- hyperactivity
- seizure
- coma
- learning disability[1]
Neck
- Neck examination of patients with lead poisoning is usually normal.
Lungs
- Pulmonary examination of patients with lead poisoning is usually normal.
Heart
- Cardiovascular examination of patients with lead poisoning might experience chest pain.
Abdomen
Abdominal examination of patients with lead poisoning might reveal[3]:
Back
- Back examination of patients with lead poisoning is usually normal.
Genitourinary
- Genitourinary examination of patients with lead poisoning might show:
- Acute nephropathy - manifests with tubular defects, including phosphaturia, glucosuria and amino aciduria. This combination of tubular defects is referred as Fanconi’s syndrome.
- Chronic nephropathy - characterized histologically with chronic interstitial nephritis and is associated with gout and hypertension.
Neuromuscular
- Neuromuscular examination of patients with lead poisoning might manifest with the following:[4] [6]
- Patient is usually oriented to persons, place, and time
- Delirium
- Hallucinations
- Weakness of extensor muscles (eg, foot drop, wrist drop)
- Hypersomnolent or have difficulty falling asleep
- ataxia
- aggressiveness
- attention difficulty
Extremities
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References
- ↑ 1.0 1.1 Strayhorn JC, Strayhorn JM (2012). "Lead exposure and the 2010 achievement test scores of children in New York counties". Child Adolesc Psychiatry Ment Health. 6 (1): 4. doi:10.1186/1753-2000-6-4. PMC 3292821. PMID 22269775.
- ↑ Mottier DM, Cargnel E (2017). "[Abdominal pain as a presentation by lead poisoning. Case report]". Arch Argent Pediatr. 115 (2): e96–e98. doi:10.5546/aap.2017.e96. PMID 28318192.
- ↑ 3.0 3.1 3.2 Sachdeva C, Thakur K, Sharma A, Sharma KK (2018). "Lead: Tiny but Mighty Poison". Indian J Clin Biochem. 33 (2): 132–146. doi:10.1007/s12291-017-0680-3. PMC 5891462. PMID 29651203.
- ↑ 4.0 4.1 Talbot A, Lippiatt C, Tantry A (2018). "Lead in a case of encephalopathy". BMJ Case Rep. 2018. doi:10.1136/bcr-2017-222388. PMID 29523605.
- ↑ Nogué S, Culla A (2006). "Images in clinical medicine. Burton's line". N Engl J Med. 354 (20): e21. doi:10.1056/NEJMicm050064. PMID 16707743.
- ↑ Ying XL, Gao ZY, Yan J, Zhang M, Wang J, Xu J; et al. (2018). "Sources, symptoms and characteristics of childhood lead poisoning: experience from a lead specialty clinic in China". Clin Toxicol (Phila). 56 (6): 397–403. doi:10.1080/15563650.2017.1391392. PMID 29078718.