Lead poisoning and smoking - based on Sunflower Paediatrics 4th Ed

1. CHRONIC POISONING
Rosshini Jagatheswaran
0901135

2. Lead Poisoning
Sources
Lead based paint ingestion or inhalation
Lead fumes from burning batteries
Lead shot for fishing
Lead from old water pipes
Lead from vehicle exhaust fumes (in the past)

3. Clinical Features
• Pica
• Anorexia
• Colicky
abdominal pain
• Irritability
• Failure to thrive
• Pallor
Severe poisoning
• Drowsiness
• Convulsions
• Coma from lead
encephalopathy
• Raised ICP with
papilloedema may be present
*Chronic exposure to low levels
may harm cognitive
development

4. Diagnosis
• Gold standard : measuring blood lead
levels (<5 µg/dL)
• Hypochromic anaemia and basophilic
stippling of neutrophils or RBC
• X-ray of knee or wrist may show ‘lead
lines’ (dense metaphyseal bands)

5. Basophilic stippling of RBC. Erythrocytes display
small blue dots at the periphery. These dots are
the visualization of ribosomes and can often be
found in the peripheral blood smear. Also seen is
megaloblastic anemia

6. Lead poisoning. Opaque metaphyseal bands in the
lower femur, upper tibia, and the upper fibula
secondary to lead poisoning in a child.

7. Treatment
• Source of lead identified and removed
• A child with a venous BLL 45 μg/dL or
higher should be treated with medication
• Chelating agents are used to from non
toxic lead compounds
• Mild- Penicillamine (orally)
• Severe- sodium calcium edetate (EDTA)
parenteral

8. Smoking
• Long term effects include chronic
bronchitis, lung cancer and cardiovascular
disease
• Greater incidence of bronchitis, asthma,
pneumonia and serous otitis media in
children who parent/carers smoke
• Sudden Infant Death Syndrome

9. • Health education to children is needed to
curb smoking; especially in school going
age and adolescents
• Smoking cessation in adolescents
includes the 5 A's (Ask, Advise, Assess,
Assist, and Arrange) and use of nicotine
replacement therapy in addicted teens