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:

• Burton's line

• Peripheral neuropathy

• Wrist drop

• Learning disability

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 :
• Burton's lines
• Icteric sclera
• Headache
• Metallic taste
• Irritability
• Insomnia
• excess lethargy
• hyperactivity
• seizure
• coma
• learning disability

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:

• Abdominal pain
• Nausea
• constipation
• diarrhea
• vomiting
• poor appetite
• weight loss

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:
• 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

Extremities

• Foot drop
• Wrist drop
• Peripheral neuropathy

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