Lead poisoning differential diagnosis: Difference between revisions

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{{Lead poisoning}}
{{Lead poisoning}}
{{CMG}}; {{AE}} Aksiniya K. Stevasarova, MD
{{CMG}}; {{AE}}{{AKS}}


==Overview==
==Overview==
[[Lead poisoning]] must be differentiated from [[megaloblastic anemia]], [[carpal tunnel syndrome]], [[Guillain–Barré syndrome]], [[renal colic]], [[appendicitis]], [[encephalitis]] in adults, and [[viral gastroenteritis]] in children.<ref name="Henretig061316"/>, [[constipation]], abdominal colic, iron deficiency, [[subdural hematoma]], [[neoplasm]]s of the central nervous system, emotional and behavior disorders, and [[intellectual disability]].<ref name="Mycyk05-463"/>
[[Lead poisoning]] must be differentiated from [[megaloblastic anemia]]<ref name="pmid17405745">{{cite journal| author=Fonte R, Agosti A, Scafa F, Candura SM| title=Anaemia and abdominal pain due to occupational lead poisoning. | journal=Haematologica | year= 2007 | volume= 92 | issue= 2 | pages= e13-4 | pmid=17405745 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17405745  }} </ref>, [[carpal tunnel syndrome]]<ref name="pmid19996545">{{cite journal| author=Dsouza HS, Dsouza SA, Menezes G, Thuppil V| title=Evaluation and treatment of wrist drop in a patient due to lead poisoning: case report. | journal=Ind Health | year= 2009 | volume= 47 | issue= 6 | pages= 677-80 | pmid=19996545 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19996545  }} </ref>, [[Guillain–Barré syndrome]], [[renal colic]], [[appendicitis]], [[encephalitis]] in adults, and [[viral gastroenteritis]] in children.<ref name="Henretig061316"/>, [[constipation]], [[abdominal colic]]<ref name="pmid17634699">{{cite journal| author=Shiri R, Ansari M, Ranta M, Falah-Hassani K| title=Lead poisoning and recurrent abdominal pain. | journal=Ind Health | year= 2007 | volume= 45 | issue= 3 | pages= 494-6 | pmid=17634699 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17634699  }} </ref>, [[iron deficiency]], [[subdural hematoma]], [[neoplasms of the central nervous system]], emotional and behavior disorders, and [[intellectual disability]].<ref name="Mycyk05-463"/> <ref name="pmid17718907">{{cite journal| author=Herman DS, Geraldine M, Venkatesh T| title=Evaluation, diagnosis, and treatment of lead poisoning in a patient with occupational lead exposure: a case presentation. | journal=J Occup Med Toxicol | year= 2007 | volume= 2 | issue=  | pages= 7 | pmid=17718907 | doi=10.1186/1745-6673-2-7 | pmc=2000868 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17718907  }} </ref>


==Differentiating [[Lead poisoning]] from other Diseases==
==Differentiating [[Lead poisoning]] from other Diseases==
*As [[lead poisoning]] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular clinical symptom. For example [[sideroblastic anemia]] must be differentiated from other diseases that cause [[basophilic stippling]] like [[megaloblastic anemia]].
*As [[lead poisoning]] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular clinical symptom. <ref name="pmid22468050">{{cite journal| author=D'souza HS, Dsouza SA, Menezes G, Venkatesh T| title=Diagnosis, evaluation, and treatment of lead poisoning in general population. | journal=Indian J Clin Biochem | year= 2011 | volume= 26 | issue= 2 | pages= 197-201 | pmid=22468050 | doi=10.1007/s12291-011-0122-6 | pmc=3107416 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22468050  }} </ref>
**[[Sideroblastic anemia]] must be differentiated from other diseases that cause [[basophilic stippling]] like [[megaloblastic anemia]]<ref name="pmid17405745">{{cite journal| author=Fonte R, Agosti A, Scafa F, Candura SM| title=Anaemia and abdominal pain due to occupational lead poisoning. | journal=Haematologica | year= 2007 | volume= 92 | issue= 2 | pages= e13-4 | pmid=17405745 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17405745  }} </ref>.
**[[Peripheral neuropathy]] must be differentiated from [[Guillain–Barré syndrome]], which will present with [[albuminocytological dissociation]] on [[CSF analysis]].
**[[Intellectual disability]] must be differentiated from [[autism]], [[Down syndrome]], [[Fragile X syndrome]]
**[[Abdominal colic]] must be differentiated from [[Gallbladder disease]], [[viral gastroenteritis]], [[pancreatitis]] etc.<ref name="pmid17634699">{{cite journal| author=Shiri R, Ansari M, Ranta M, Falah-Hassani K| title=Lead poisoning and recurrent abdominal pain. | journal=Ind Health | year= 2007 | volume= 45 | issue= 3 | pages= 494-6 | pmid=17634699 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17634699  }} </ref>
 


===Preferred Table===
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
| colspan="6" rowspan="1"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''
! colspan="7" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
| colspan="1" rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''
! colspan="3" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
| style="background: #F5F5F5; padding: 5px;" |
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #F5F5F5; padding: 5px;" |
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #F5F5F5; padding: 5px;" |
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
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| style="background: #F5F5F5; padding: 5px;" |
|}


==References==
==References==

Latest revision as of 20:39, 21 June 2018

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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

Lead poisoning must be differentiated from megaloblastic anemia[1], carpal tunnel syndrome[2], Guillain–Barré syndrome, renal colic, appendicitis, encephalitis in adults, and viral gastroenteritis in children.[3], constipation, abdominal colic[4], iron deficiency, subdural hematoma, neoplasms of the central nervous system, emotional and behavior disorders, and intellectual disability.[5] [6]

Differentiating Lead poisoning from other Diseases


References

  1. 1.0 1.1 Fonte R, Agosti A, Scafa F, Candura SM (2007). "Anaemia and abdominal pain due to occupational lead poisoning". Haematologica. 92 (2): e13–4. PMID 17405745.
  2. Dsouza HS, Dsouza SA, Menezes G, Thuppil V (2009). "Evaluation and treatment of wrist drop in a patient due to lead poisoning: case report". Ind Health. 47 (6): 677–80. PMID 19996545.
  3. 4.0 4.1 Shiri R, Ansari M, Ranta M, Falah-Hassani K (2007). "Lead poisoning and recurrent abdominal pain". Ind Health. 45 (3): 494–6. PMID 17634699.
  4. Herman DS, Geraldine M, Venkatesh T (2007). "Evaluation, diagnosis, and treatment of lead poisoning in a patient with occupational lead exposure: a case presentation". J Occup Med Toxicol. 2: 7. doi:10.1186/1745-6673-2-7. PMC 2000868. PMID 17718907.
  5. D'souza HS, Dsouza SA, Menezes G, Venkatesh T (2011). "Diagnosis, evaluation, and treatment of lead poisoning in general population". Indian J Clin Biochem. 26 (2): 197–201. doi:10.1007/s12291-011-0122-6. PMC 3107416. PMID 22468050.

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