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N827 > Environmental Issues > Flashcards

Environmental Issues Flashcards

1
Q

Toxicants are linked to…

A
  • Miscarriage
  • IGR
  • Low birth weight
  • Preterm birth
  • Birth defects
  • Motor and cognitive delays
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2
Q

Breathing Zone

A
  • For an adult: typically 4-6’ above the floor
  • A child is closer to the floor where heavier chemicals (i.e. mercury, large breathable particles) settle out
  • Children are smaller than adults; their metabolic rate is higher than adults; they consume more O2
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3
Q

Harmful Exposure Target Organs

A
  • Poor fetal/childhood growth
  • Diminished IQ
  • Precocious puberty
  • Small head size
  • Diminished lung capacity
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4
Q

Deadly Pediatric Poisons (Meds)

A
  • CCBs
  • TCAs
  • Lomotil
  • Opiates
  • Salicylates
  • Toxic ETOHs
  • Sulfonylureas
  • Camphor
  • Clonidine and imidazoline
  • Antimalarials
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5
Q

Pesticide Poisoning

A
  • Specifically organophosphates and carbamates
  • Work by inhibiting cholinesterase
  • Present with cholinergic Sx (coma/stupor, flaccidity, dyspnea, miosis, salivation, GI signs, clammy)
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6
Q

Nicotinic Symptoms

A
  • ** Days of the Week ***
  • M ydriasis
  • T achypnea
  • W eakness
  • T achycardia
  • F asciculations
  • Weekend (wee ones)
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7
Q

Hydrocarbon poisoning

A
  • Aliphatic: Kerosene, turpentine, lubricating oils, tar –> aspiration and pulmonary Sx
  • Aromatic: benzene compounds –> hepatic toxicity and neurologic Sx
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8
Q

Heavy Metal Toxicity

A
  • Lead
  • Mercury
  • Arsenic
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9
Q

Why is lead dangerous?

A
  • More hand-to-mouth

- Play on floor

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10
Q

Common Sources of Lead

A
  • Paint and dust
  • Soil
  • Water
  • Toys, vinyl miniblinds
  • Pottery from foreign places
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11
Q

Other Sources of Lead

A
  • Keys
  • Pewter
  • Home remedies (Azarcon, Greta)
  • Glaze on bathtubs
  • Soil contaminated from gasoline
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12
Q

S/S of lead toxicity

A
  • Fatigue, irritablity, lethargy, paresthesias, myalgias
  • ABD pain, tremor HA, vomiting, weight loss, constipation
  • Loss of libido, motor neuropathy, encephalopathy, cerebral edema, seizures
  • Coma, epiphyseal lead lines (growth arrest)
  • Renal failure
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13
Q

Toxicokinetics and Toxicodynmics of Lead

A
  • Absorption:
  • Lungs
  • GI: Adults 20-30%; Children ~50% (inadequate intake of Fe, Ca, and total cal associated with higher Pb levels)
  • Skin: inorganic NOT absorbed, organic absorbed
  • Lead is carried bound to RBC
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14
Q

Pharmacokinetics and Pharmacodynamics of Lead

A
  • Distributed extensively throughout tissues: bone, teeth, liver, lung, kidney, brain, spleen
  • Bones constitute a source of Pb storage and continued toxicity after exposure has ceased
  • Pb crosses the blood brain barrier and concentrates in gray matter
  • Crosses placenta
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15
Q

Lead Levels

A
  • Average ~2mcg/L
  • Acceptable is 5mcg/L
  • IQ/growth impaired at >10mcg/L
  • Nerve damage at >20mcg/L
  • Impaired Vd synthesis at >30mcg/L
  • Hgb synthesis impaired at >40
  • ABD pain and neuropathy at >50
  • Encephalopathy, anemia, seizures, nephropathy at >100
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16
Q

Neurotoxicity of Pb in Childhood

A
  • MR in severe Pb intoxication
  • Down 5pts in IQ for q 10mcg/L increase in Pb blood level
  • Other adverse outcomes: aggression, hyperactivity, antisocial behaviors, learning disabilities
17
Q

Pb Screenings

A
  • 12mo w/Hgb
  • 24mo (levels typically higher)
  • Once before 6yr if not done sooner
18
Q

Pb Toxicity Dx

A
  • Evaluation of S/S
  • CBC-diff
  • Serum ferritin, TIBC
  • ABD XR
  • Whole blood Pb level
19
Q

Tx Pb Toxicity

A
  • Environmental inspection/reduction
  • Nutritional supplementation
  • Chelation
  • Nutritional Supplementation: Fe, Ca, phos, frequent foods
20
Q

Chelation

A
  • BLL >70 or encephalopathy: hospital admit, parenteral chelator
  • BLL >45: oral chelator
  • BLL 25-45: if these levels persist despite environmental intervention, then treat
21
Q

Mercury

A
  • Occurs in 3 forms: elemental (liquid, volatizes), inorganic (caustic, dermal exp), and organic (lipid soluble; GI, lungs, skin absorb)
  • Contamination results from mining, smelting, and industrial discharge
  • Can be found in fish, thermometers, dental amalgams, fluorescent light bulbs, disc batteries, electrical switches, folk remedies, chemistry sets, vaccines
22
Q

Elemental Mercury

A
  • At high concentrations, vapor inhalation produces acute necrotizing bronchitis, pneumonitis, and death
  • Long-term exposure effects include:
  • Early: Insomnia, forgetfulness, anorexia, mild tremor
  • Late: Progressive tremor, erethism (red palms, emotional lability, memory impairment
  • Salivations, diaphoresis, renal toxicity
  • ** Dental amalgams do not pose health risk
23
Q

Inorganic Mercury

A
  • GI ulceration or perforation and hemorrhage are rapidly produced, followed by circulatory collapse
  • Breakdown of mucosal barriers leads to increased absorption and distribution to the kidneys
  • Acrodynia (pink disease) usually from dermal exposure –> maculopapular rash, swollen/painful extremities, peripheral neuropathy, HTN, renal tubular dysfunction
24
Q

Organic Mercury

A
  • Toxicity occurs with long-term exposure and effects from the CNS (paresthesias, ataxia, general weakness, visual/hearing impairment, tremor/muscle spasticity, coma/death)
  • Teratogen with Lg chronic exposure
  • Infants may appear NL at birth but psychomotor retardation, blindness, deafness, and seizures develop over time
25
Q

Mercury: Prevention

A
  • Elemental Mercury spills: 1) roll onto a sheet of paper and place in airtight container, 2) never use vacuum to prevent vaporization, and 3) consult with environmental cleaning company
26
Q

Arsenic: Sources

A
  • Groundwater
  • Mineral ores
  • Industry: Semiconductor manufacturing; fossil fuels; treated wood; metallurgy; smelting and refining of metals; glass manufacturing; pesticides; herbicides, fungicides; anti-parasitic drugs; folk remedies
27
Q

Arsenic toxicity: S/S

A
  • Thirst, HoTN, burning mucosa; N/V/D; ABD pain; hematemesis/hematochezia; hemolysis; pancytopenia, etc.
28
Q

Arsenic: Tx

A
  • Gastric lavage
  • Activated charcoal does NOT bind well with arsenic
  • Bowel irrigation with polyethylene glycol
  • skin decontamination

N827 (19 decks)

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