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 K. Stevasarova, MD
Overview
Patients with chronic lead poisoning usually appear very sick. Physical examination of patients with lead poisoning is usually remarkable for neurological, gastrointestinal, and [[hematological] problems.
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 :
- Icteric sclera
- Headache
- Metallic taste
- Irritability
- Insomnia
- excess lethargy
- hyperactivity
- seizure
- coma
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:
Back
- Back examination of patients with lead poisoning is usually normal.
Genitourinary
- Genitourinary examination of patients with lead poisoning is usually normal, but they might have some level or renal impairment.
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- Patient is usually oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
- Extremities examination of patients with [disease name] is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
The symptoms of chronic lead poisoning include neurological problems, such as
reduced cognitive abilities
- excess lethargy
There are also associated gastrointestinal problems, such as
Other associated effects are
- kidney problems
- reproductive problems
Physical examination
Laboratory tests
- Basophilic stippling of red blood cells
- Iron deficiency anemia (microcytosis and hypochromia)
- Elevated serum lead levels
- K-fluorescent X-ray metering can measure bone-lead.
Shown below is an image depicting basophilic stippling in a blood smear of a patient with lead poisoning.
