Heavy Metal Toxicity

    Table of contents
    1. 1. Lead
    2. 2. Iron





    • Usually industrial exposure, such as battery manufacturing plant.
    • Symptoms:
      • Hypertension
      • Gout
      • Chronic Kidney Disease (Chronic lead exposure in industry), often one of:
        • Chronic tubulointerstitial nephritis causing proteinuria (with rare leukocytes and erythrocytes in urine sediment).
        • Fanconi syndrome (glycosuria, normoglycemia, hyperuricemia, hypophosphotemia, aminoaciduria). 
    • Testing:
      • Chelation mobilization testing.
        • For long-term lead load and for previous lead exposure. (important in CKD etc..)
        • 90% of total lead in bones (blood levels not adequate indicator)
        • Technique: give chelating agent EDTA --> mobilizes lead deposited in tissues --> measure urine.
      • Erythrocyte protoporphyrin levels
        • For acute exposure. (useless for past exposure)
      • Xrays of long bones
        • In pediatrics (metaphysis of growing bones lights up)
      • Blood smear
        • Basophilic stripping of erythrocytes (also seen in megaloblastic anemia)


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