CO2 & Lead Poisoning... Flashcards
What are the major sources of CO2 poisoning versus Lead poisoning?
CO2 = chemical produced from incomplete burning of natural gas or other products containing CO – coal, gasoline, kerosene, oil, propane, or wood, Automobile engines, Charcoal grills indoors, Indoor/outdoor portable heating systems, Portable propane heaters, Stoves, Water heater that use natural gas
LEAD = House paint before 1978, Toys/furniture painted before 1976, Painted toys & decorations made outside the U.S., Lead bullets, fishing sinkers, curtain weights.
Plumbing, pipes, & faucets, drinking water in homes containing pipes that were connected with lead solder, Soil contaminated by decades of car exhaust or years of house paint scrapings, Hobbies involving soldering, stained glass, jewelry making, pottery glazing, and miniature lead figures, Children’s paint sets/art supplies,Pewter pitchers & dinnerware, Storage batteries.
What is a biochemical name of a compound, resulted in attachemnt of CO to hemoglobin molecule? Carboxy-hemoglobin? Carbamino-hemoglobin? Oxy-hemoglobin? Myoglobin?
The blood carries oxygen & CO in the physically dissolved
state & in combo w. hemoglobin. CO2 also is converted to bicarbonate & transported in that form
What are the major patho-mechanisms of CO versus Lead poisoning: briefly describe pathogenesis of each?
- – Carbon monoxide poisoning is caused by inhaling combustion fumes. When there’s too much CO in the air, your body replaces the oxygen in the hemoglobin of your red blood cells with CO. This keeps life-sustaining oxygen from reaching your tissues & organs.
- – Absorbed lead enters the blood & soft tissues & eventually redistributes to the bone. The degree of absorption & retention is influenced by dietary factors such as calcium or iron levels. In ruminants, particulate lead lodged in the reticulum slowly dissolves & releases significant quantities of lead. Lead has a profound effect on sulfhydryl-containing enzymes, the thiol content of erythrocytes, antioxidant defenses, & tissues rich in mitochondria, which is reflected in the clinical syndrome. In addition to the cerebellar hemorrhage & edema associated with capillary damage, lead is also irritating, immuno suppressive, gametotoxic, teratogenic, nephrotoxic, & toxic to the hematopoietic system.
What are the major clinical presentations of acute CO poisoning? Chronic CO poisoning? Lead poisoning?
CO — H/A & nausea can begin when levels are 10 to 20%.
Levels > 20% cause vague dizziness, generalized weakness, difficulty concentrating, & impaired judgment.
Levels > 30% commonly cause dyspnea during exertion, chest pain (in patients with coronary artery disease), & confusion.
Higher levels can cause syncope, seizures, & obtundation.
Hypotension, coma, respiratory failure, & death may occur, usually when levels are > 60%.
LEAD —-Symptoms are roughly proportional to lead levels, but there are no safe levels of lead. Risk of cognitive deficits increases when the whole blood lead level (PbB) is ≥ 10 μg/dL (≥ 0.48 mmol/L) for an extended period, although the cutoff may be even lower. Other symptoms (eg, abd cramping, constipation, tremors, mood changes) may occur if PbB is > 50 μg/dL (> 2.4 mmol/L). Encephalopathy is likely if PbB is > 100 μg/dL (> 4.8 mmol/L). Anemia is likely.
What is an appropriate strategy of tx. & prevention of each CO & Lead poisoning?
LEAD — 1.) Source of lead eliminated (eg, whole-bowel irrigation if lead in GI tract) 2.) Chelation for adults w. symps of poisoning plus PbB > 70 μg/dL3.) Chelation for children w. encephalopathy or PbB > 45 μg/dL (> 2.15 mmol/L)
CO — 1.) 100% O2, 2.) Possibly hyperbaric O2 for px’s w:
Life-threatening cardiopulmonary complications, Ongoing chest pain, Altered consciousness, Loss of consciousness (no matter how brief), A carboxyhemoglobin level > 25%, Pregnancy
Why children are more vulnerable to complications of Lead poisoning?
children 2 & under more likely than older children to put lead-contaminated hands or toys or paint chips in their mouths. Moreover, a child’s GI tract also absorbs lead more readily than does the adult gut. A child’s rapidly developing brain is highly vulnerable to lead toxicity.
How are CO & Lead poisoning usually diagnosed?
LEAD: BLL - Blood level test, LeadCare II Blood Lead Test System, Bone marrow biopsy, Complete blood count (CBC) & coagulation studies, Erythrocyte protoporphyrin, X-ray of the long bones & abdomen
CO: CO2 home detector, health care provider will measure & monitor the patient’s vital signs, including temperature, pulse, breathing rate, & BP. Patient may receive: Hyperbaric oxygen therapy, Medicines to treat symptoms, Oxygen
________________ is a stable complex of carbon monoxide that forms in red blood cells when CO is inhaled. COHb should be measured if CO or methylene chloride poisoning is suspected. COHb is also useful in monitoring the treatment of carbon monoxide poisoning.
Carboxyhemoglobin (COHb)
_________________ is a chemical complex formed by CO2 & hemoglobin after the release of oxygen by the hemoglobin to a tissue cell. The action is similar to that of the formation of a carbamino compound. It accounts for nearly 25% of the carbon dioxide released in the lung.
Carbamino-hemoglobin (CO2 HHb)
___________ the product of combining hemoglobin with oxygen. The loosely bound complex dissociates easily when the concentration of oxygen is low. A compound of hemoglobin with two atoms of oxygen.
Oxy-hemoglobin (Hemoglobin is a protein molecule that binds to oxygen. Hemoglobin forms an unstable, reversible bond with oxygen. In its oxygen-loaded form, it is called oxyhemoglobin and is bright red. In the oxygen-unloaded form it is called deoxyhemoglobin and is purple-blue)
_________ an iron & oxygen-binding protein found in the muscle tissue of vertebrates in general & in almost all mammals. It is related to hemoglobin, which is the iron- & oxygen-binding protein in blood, specifically in the red blood cells. _________ is only found in the bloodstream after muscle injury. It is an abnormal finding, and can be diagnostically relevant when found in blood.
Myoglobin (contains hemes, pigments responsible for the color of red meat)
if person is unconscious, how would you know it’s from CO poisoning?
dark, cherry red lips, mucosa. in severe cases, cheeks (likely already dead at this point) = carboxyhemoglobin color
how do we differentiate CO poisoning?
severe poisoning: dark cherry red color (of carboxy-hemoglobin
drowsy memory, fatigue, headache, diff. with breathing, dis-coordinated movement, depression, fatigue tired: normal, if you go to sleep, and when you wake up you have energy again fatigue: sleep or rest won’t improve the condition are all S&S of ______ ___ poisoning
chronic CO
where do we get lead?
paint, soil, old infrastructure, pipe, glass, mirrors, ceramics, make-up, weapons,
