A Heavy Burden: Lead Poisoning in an Adult Woman
Anthony Bhe, MD; Timothy Albertson, MD, MPH, PhD
University of California, Davis Medical Center; Sacramento, CA
Images
Discussion
Learning Objectives
Lead poisoning
• Like other “great mimickers,” lead toxicity
presents with a diverse set of signs and symptoms
that include central and peripheral neuropathy, as
well as GI, renal, and hematologic manifestations.
Lead poisoning is common in children, rare in adults.
Most adult exposures are occupational.
Absorption via respiratory and oral routes.
Acute toxicity: constipation, colic, hemolytic anemia
and encephalopathy.
• Chronic toxicity: Fatigue, abdominal pain,
encephalopathy, neuropathy, anemia, nephrotoxicity,
hypertension.
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Abdominal series
Upright (L) and lateral
decubitus (R), showing
non-obstructive bowel gas
pattern.
• Geophagy is a form of pica that increases risk of
exposure to heavy metal ingestion.
Geophagy
Case Description
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HPI: 44 year old Spanish-only speaking woman
presented to the ED after 1 week of abdominal
pain, nausea, vomiting and diarrhea. For 2 days
prior to admission she has been constipated and
unable to tolerate oral intake. She also notes that
she has had worsening pain in her legs for the last
week, and has chronic paresthesias in her hands.
She has had no recent sick contacts, exposure to
wildlife, streams, chemicals or antibiotics.
Blood smear
Note microcytic, hypochromic
erythrocytes with basophilic stippling
(arrows).
Exam: Vital signs were within normal limits. The
remainder of her exam was notable for pale skin,
lethargy and tenderness in her LLQ and bilateral
feet.
Laboratory Studies
136 99 12
3.8 27 0.71
8.5
9.4
30.2
229
MCV 68.3
RDW 17.6
115
Prot
Alb
Alk Phos
AST
ALT
Tbili
Dbili
6.7
3.8
72
72
93
1.1
0.2
U/A – 5.5, 1.006, trace LE,
no blood/nitrite
UPT – negative
Practice of eating clay, soil or chalk.
Common in animal and human world.
Most widely described among pregnant women.
Case reports from across the globe:
• Proposed reasons for geophagy:
o Alleviate hunger.
o Treatment for GI distress or infection.
o Detoxification of food sources.
o Source of micronutrients.
On further questioning, the patient
and daughter admitted that
immediately prior to symptom onset,
the patient had consumed part of a
small, glazed ceramic pot:
• Studies of commonly ingested clays:
o Provides free Ca, Mn, Mg
o Binds Fe
o Samples high in Pb, As, Cd, Hg
Blood lead level: 109 mcg/dL
Photo credit: http://www.oregonlive.com/health/index.ssf/2010/11/fda_warns_consumers_about_lead.html
References & Acknowledgements
Hospital Course
• The patient underwent whole bowel irrigation and started succimer 10
mg/kg PO tid.
• She improved clinically, and was discharged from the hospital 6 days later
on 14 additional days of oral succimer treatment.
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Voltaire Sinigayan, MD
Caroline McCoach, MD
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