Poisoning                       Lead
                                ====

þ Adult Acute Lead Toxidrome:
 - headaches
 - fatigue
 - arthralgias
 - loss of libido

þ Lead levels notoriously poor at predicting total body lead burden.

þ Chronic Lead Poisoning Effects, Signs and Symptoms:
 - gingival lead lines
 - wrist drop or foot drop without sensory involvement.
 - constipation
 - "lead colic" with marked rigidity of abdominal muscles
 - metallic taste in mouth
 - inhibits Hgb synthesis so marked reticulocytosis and microcytic hypochromic
   anemia.
 - basophilic stippling of rbcs (but nonspecific)
 - hypertension
 - direct myocardial toxicity
 - hyperuricemia and gout

þ Lead Levels for Construction Workers
  < 40:  safe
  40-60: requires monitoring
  > 60 remove from work area

þ Political:  Lead Paint Poisoning Act of 1971, outlawed
  residential lead paint in 1977; lead paint still used on
  bridges, etc.

þ Note that removing lead paint can cause severe exposures if
  not conducted correctly.

þ Drugs of abuse often contaminated with lead:
  - lead used in manufacture of methamphetamine:  some on
    street is 60% lead by weight (lead acetate used in
    intermediate step)
  - heroin may be diluted ("cut") with materials including
    lead; some reported to have up to 30 mg/gm.
  - intentional inhalation of leaded gasoline may lead to lead
    poisoning
  - moonshine may be contaminated with lead

þ Unusual sources of lead poisoning:
  - Wine bottles may have lead on rim from lead foil
  - Lead glazes on improperly fired amateur/homemade crockery
    may leach lead, especially beverage mugs and imported
    pottery

þ Traditional remedies and natural herbal medicines:
  - Mexican-American:
    + Azarcon (lead tetroxide--orange powder) and
    + Greta (lead oxide--yellow powder)
    used for "empacho" (GI problems) but may lead to worse GI
    complaints from lead poisoning, resulting in more use and
    severe lead poisoning.
  - Chinese: Pay-loo-ah used by Hmong immigrants, also high
    lead content
  - Folk medicines from India sometimes contain up to 6% lead
    and reported to cause poisoning
    [Clinical Toxicology Forum 1992;(4)2 and other misc. sources]
  - LITARGIRIO (pronounced "lee-tar-heario")
   + consumer product from South America
   + associated with childhood lead poisoning in Rhode Island.
   + yellow or peach-colored powder manufactured by Roldan, Ferreira and
     other laboratories in Santo Domingo, Dominican Republic.
   + nearly 80 per cent lead
   + used as a childhood anti-perspirant/deodorant.
   + traditional remedy for treating fungus on the feet and for burns.
   + easily purchased in convenience and specialty stores catering to
     Spanish-speaking customers
  - Pennsylvania's toll-free Lead Information Line at 1-800-440-LEAD
    (5323).