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INTERNAL MEDICINE > CHAPTER 449 HEAVY METAL POISONING > Flashcards

CHAPTER 449 HEAVY METAL POISONING Flashcards

1
Q

LEAD METABOLISM

A

interferes with the mitochondrial oxidative phosphorylation and enhances the oxidation and cell apoptosi

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2
Q

HOW LEAD IS ABSORBED?

A

thru inhalation and ingestion

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3
Q

half life of lead in soft tissues and bone

A

soft tissue- 30 days

bone- >20 years

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4
Q

LEAD IS EXCRETED THRU?

A

URINE BUT SOME CAN BE FOUND IN THE BREASTMILK

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5
Q

ACUTE EXPOSURE OF LEAD

A

> 60 TO 80 mg
impair neurotransmission and neuronal cell death
impair hematopoiesis
renal tubular dysfunction

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6
Q

HIGHER LEAD EXPOSURE

A

> 80-120
Acute encephalopathy with convulsions
coma
death

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7
Q

SUBACUTE EXPOSURE IN CHILDREN OF LEAD

A

25-60 mg
anemia
mental retardation
deficits in language, motor function, language, hearing, balance, behavior and school performance

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8
Q

SUBACUTE EXPOSURE IN ADULTS OF LEAD

A 
>40mg
risk for anemia
demyelinating peripheral neuropathy
impairment of reaction time and hearing 
decline in recognition
risk for cardiovascular  disease
death
renal failure
diminished sperm count
spontaneous abortions
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9
Q

DIAGNOSIS OF LEAD EXPOSURE IN CHILDREN

A 
abdominal pain
irritability
lethargy
anorexia
anemia
fanconi syndrome
pyuria
azotemia
epiphyseal plate lead lines in long bone xray
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10
Q

coma happens at what level of blood lead

A

> 120 mg

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11
Q

diagnosis of lead toxicity in adult

A 
headaches
myalgias
depression
memory loss
loss of libido
lead line at the gingiva
pallor
wrist drop
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12
Q

lab test in lead toxicity

A

normocytic normochromic anemia
basophilic strippling
elevated blood protoporphyrin level
motor delays in conduction

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13
Q

TREATMENT OF LEAD TOXICITY

A

chelation with oral DMSA (succimer)

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14
Q

acutely exposed treatment of lead

A

hospitalization with IM or IV chelation with CaEDTA addition with dimercaprol

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15
Q

what is the use of addition of dimercaprol in lead toxicity treatment

A

to avoid worsening of encephalopathy

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16
Q

weak but natural chelating agent of lead toxicity

A

vitamin c

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17
Q

shown to lower lead levels in pregnant woman

A

calcium supplementation (1200 mg at bedtime)

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18
Q

main source of mercury

A

dispersed in waste incineration, bacteria convert inorganic to organic build up in aquatic food chain contaminate fishes

19
Q

metabolism of mercury

A

binds to sulfhydryl groups and interferes with enzymatic process

20
Q

what type of mercury that is well absorbed and not well absorbed

A

elemental mercury not well absorbed but highly volatilize into highly absorbable vapor while inorganic mercury is absorbed thru gut and skin and organic mercury thru inhalation and ingestion

21
Q

what type of mercury can cross blood brain barrier and placenta

A

elemental and organic

22
Q

mercury is excreted in

A

urine and feces

23
Q

half life of mercury

A

in blood- 60 days

but will remain in kidney and brain for years

24
Q

acute inhalation of vapor mercury can cause

A

pneumonitis and noncardiogenic pulmonary edema leading to death

25
Q

chronic high exposure of vapor mercury can lead to

A

CNS toxicity, impair renal function and memory and coordination

26
Q

acute ingestion of inorganic mercury can lead to

A

gastroenteritis and nephritic syndrome and acute renal failure , hypertension and tacycardia

27
Q

death can occur in how many ingestion of mercury

A

10-42 mg

28
Q

ingestion of organic mercury can lead to

A

gastroenteritis, arrythmias and lesions in basal ganglia, gray matter and cerebellum doses of >1.7 mg

29
Q

high exposure of mercury during pregnancy can lead to

A

derangement of fetal neuronal migration results to severe mental retardation

30
Q

mild exposure (From fish) of mercury during pregnancy lead to

A

decline in neurobehavioural performance of the offspring

31
Q

compound of mercury that is super toxic and one drop can lead to severe cerebellar degeneration and death via skin inhalation

A

dimethylmercury

32
Q

diagnostic of metallic mercury ingestion via P.E

A

intention tremor and mercurial erethism, excitability and memory loss, insomia and timidity

33
Q

children exposed to mercury results to

A 
acrodynia (pink disease)
flushing
itching
swelling
tacycardia
hypertension
excessive salivation 
morbilidiform rashes
desquamation of palms and soles
34
Q

toxicity will happen if blood levels and urine levels of mercury is

A

> 180 mg - blood

>0.7 mg- urine

35
Q

how do you measure organic mercury exposure

A

levels in the blood if acute

hair if chronic

36
Q

Where do children get their CNS toxicity

A

fetal exposures with maternal hair mercury >30

37
Q

how do you treat acute ingestion of mercury

A

induced vomitting and gastric lavage and polythiol residues to bind in the GI tract

38
Q

chelating agents for mercury exposure

A

dimercaprol and DMSA

39
Q

if there is renal failure during the treatment course of mercury exposure

A

treat with peritoneal dialysis, hemodialysis

40
Q

best treatment for chronic inorganic mercury poisoning

A

n-acetyl penicillamine

41
Q

where can you get arsenic exposure

A

shallow tube walls inserted for drinking water

42
Q

aluminum exposure can lead to

A

encephalopathy in px with severe renal disease who are going dialysis

43
Q

fatal cardiomyopathy in px with beer heavy consumer

A

cobalt chloride

44
Q

it can cause parkinsonian syndrome within 1-2 years including gait disorders, postural stability and masked expressionless face with psychiatric symptoms

A

manganesse

INTERNAL MEDICINE (12 decks)

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