S15C197 - Metals and Metalloids

Question 1

Lead toxicity acute Sx:

Answer 1

• CNS: encephalopathy, Sz, AMS, papilledema, optic neuritis, ataxia
• PNS: paresthesias, weakness, decreased DTR
• GI: abdo pain, constipation, diarrhea, toxic hepatitis
• Renal: fanconi syndrome (RTA)
• Heme: anemia, basophilic stippling

Question 2

Lead toxicity chronic Sx:

Answer 2

• CNS: h/a, irritable, dpn, fatigue, memory deficit
• Renal: interstitial nephritis, renal insufficiency, HTN, gout
• Heme: anemia, basophlic stipling
• GU: decreased libido, impotence, sterility, abortions, premature birth, abnormal sperm count

Question 3

Lead toxicity: dx

Answer 3

• combination of abdo and neuro dysfunction with hemolytic anemia should raise suspicion
• consider lead poisoning in all children presenting with encephalopathy
• measure serum level

Question 4

Lead toxicity: tx

Answer 4

• Sx: benzos

- chelation

Question 5

Arsenic toxicity: Sx

Answer 5

• Acute: n/v/d, HoTN, tachy, dysrhythmias, ALI, AKI, encephalopathy
• Subacute: h/a, confusion, delirium, neuropathy, long QT, cough, rash, alopecia, Mees lines
• Chronic: hyperpigmentation, keratoses, Bowen dz, SCC, BCC, DM, HTN, PVD, lung cancers

-acutely causes cerebral edema and hemorrhage

Question 6

Arsenic toxicity: dx

Answer 6

• consider in acute situation of HoTN preceded by severe gastro or in chronic situation of skin changes, neuropathy and bouts of gastra
• long QT
• arsenic levels in 24h urine

Question 7

Arsenic toxicity: tx

Answer 7

• fluids then NE for pressure
• chelation
• amiodarone for VT/VT
• MgSO4- for torsades
• Sz: benzos