AN EXTREME NEUROLOGIC PRESENTATION OF LEAD INTOXICATION
Publish place: 14th iranian annual congress of emergency medicine
Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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شناسه ملی سند علمی:
EMERGENCYMED14_012
تاریخ نمایه سازی: 26 بهمن 1398
Abstract:
Background and Aim : Drug dealers adulterated narcotics by intentional addition of impurit ies.Among the adulterants, lead salts can be optimal agents for abuse due to the similar dark color,high molecular weight and easy accessibility. Consequently chronic lead intake and toxicity hasbeen excessively increased in the opium addict population.Methods : A 57 year old woman presenting to the emergency department with sudden onsetchange in mental status, severe agitation and disorientation to time, space and person. She did nothave fever, nausea, headache, respiratory or urinary complaints. Past history was positive forhypertension for nearly 10 years and oral opium use for 17 years. Physical exam exhibited normalvital signs, no focal neurologic deficit and no signs of meningeal irritation. On neurologic exam,she screams without reason, did not cooperate, had impaired attention and calculation and thus,the evaluation of memory, sensory, equilibrium or exact orientation could not be performed.Abdomen was soft without tenderness or guarding. The examination of cranial nerves, motor, deeptendon reflexes and gait were unreliable.Results : Chest x-ray was unremarkable and electrocardiography showed sinus tachycardia.Laboratory investigations included normal blood biochemistry and complete blood count butelevated liver enzymes and positive toxicology screen for opiates. Brain spiral computedtomography (CT) scan and brain magnetic resonance imaging (MRI) did not show abnormalit ies.Normal cerebrospinal fluid, smear and analysis were detected. Due to recent high incidence of leadpoisoning, blood lead level was measured 45 g/dL (normal reference level <25 g/dL).Conclusion : She was treated with intramuscular Dimercaprol for 5 days followed by intravenousEdetate calcium disodium for 5 days and gradually the symptoms were resolved and liver enzymesturn to normal. Lead poisoning due to other causes were assessed and obviated.
Authors
Maryam Bahreini
Associate Professor of Emergency Medicine, Tehran University of Medical Sciences
Sepideh Aarabi
Associate Professor of Emergency Medicine, Tehran University of Medical Sciences
Ali Tafazoli Moghadam
Clinical Pharmacist, Shahid Beheshti University of Medical Sciences