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 :
• 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:

• 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

Physical examination

• Burton's line

• Peripheral neuropathy

• Wrist drop

• learning disability