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 role
an 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 quasievil, 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 leadinduced 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: Low
Prevalence: # 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.