Case study 1

Children with Lead Poisoning

Lead Poisoning

A.K.A. saturnism, plumbism or painter's colic

Roman’s recognized that water from terra cotta pipes was healthier than water from lead pipes

Increased lead in a kid’s knees

• Frontal radiograph of both knees of a child with lead poisoning show dense metaphyseal (metaphysis area of bone growth) bands involving not only distal femurs and proximal tibias but proximal fibulas as well

An oxide of lead was once added to wine to artificially sweeten it.

Since lead can make crystal clearer and people like to you crystal decanters there have been cases of lead poisoning due to people leaving alcoholic beverages in crystal decanters for months.

Lead: no biological rolean environmental problem of many chemicals

Lead mimics other metals like Zinc.

ALAD is a zinc binding protein in Heme (part of hemoglobin)

Genetic mutations of ALAD leads to porphyria which was the Madness of King George III

100 parts per billion

• The average person has less than 10 micrograms per deciliter, or 100 parts per billion, ppb, of lead in their blood serum.

• Symptoms show up when you’ve got 100ppb

• Higher than 200 ppb unusual

Cause your not quite evil enough. Your semi-evil, your quasi-evil, your the margarine of evil, your the diet coke of evil, just one calorie, not "evil" enough

Famous cases of Lead Poisoning

• Much of Rome's affluent class suffered from lead-induced gout

• Ludwig Van Beethoven• Francisco Goya was

considered skilled but unremarkable until he contracted lead poisoning in his late forties and painted a series of disturbing paintings called "the Caprices.

• “the sleep of reason produces monsters

1. What is the etiology of the mental and physiological signs shown by these patients?

Etiology: Source of the disease

In this case lead poisoning from the abandoned building

2. What risk factors for lead poisoning can you identify in this case study?

Risk factors: Conditions that increase the probability of having a disease

In this case the financial situation and where the people lived were risk factors

3. Is lead a toxin?

Toxin: poison produced by a living organism

No lead is not a toxin

4. Do any of the people in this story exhibit idiopathic lead poisoning? Why or why not?

Idiopathic: No apparent cause.

No the cause for every case of lead poisoning is known

5. Would you consider lead poisoning a syndrome? Why or why not?

Syndrome: Collection of signs, symptoms, degenerative processes that occur together in a disease.

Yes all of the joint pain, excessive salivating, seizures, and personality changes happened at the same time. But its debatable

6. At what point in this case does histopathology become relevant?

Histopathology: Microscopic study of disease.

In this case its relevant when blood and urine tests are done.

7. Based on the information presented, does the lead poisoning in this community show a high morbidity? A high mortality? A high prevalence? A high incidence?

Morbidity: Prevalence of disease. Yes, of course it will depend on the population

Mortality: Death rate from disease: LowPrevalence: # of people with disease at a given

span of time. Yes.Incidence: # of new cases over a given time

period: High

8. Would you consider the lead poisoning in this case an epidemic?

Epidemic: High incidence. Above normal expectations. Yes this is an epidemic

9. Identify as signs or symptoms

Signs: Objective visual indication of disease

• Salivation• Personality change• RBC• Lead in urine• Intelligence?• Vision?

Symptom: Subjective feeling only know to patient

• Joint pain• Difficulty walking?

Can a sign be faked?

10 The elderly woman with pica lives with her daughter’s family. Her daughter says she can’t get her mother to stop chewing the foil from the wine bottles, and the mother says she likes the metallic feel on her teeth. If you were the physician, what might you suggest to control the lead poisoning?

What is pica? Eating of non-nutritive substances for extended periods

Aluminum or gold foil.

I'm from Holland. Isn't that vierd?

2005 Fort Duquesne is unleaded

• 14.3 Million• Sand blasted off 1970’s

paint• Vaccum kept lead dust

from spreading• OSHA has fined

companies cleaning other Pittsburgh bridges millions for not talking proper precautions

From Leadsafepittsburgh.com

In Allegheny County, more than 90% of the homes were built prior to 1978 when lead paint was still used.

Up to 25% of the preschool children in our region have elevated blood lead _levels.

Lead and Behavior

• Prof Needleman, from Pitt suggests that increased cases of lead poisoning could cause lowered IQs and unstable personalities that will lead to increased crime in the future.

• Leading cause of lead poisoning in Texas.

• Don’t mess with Texas.