Case 1 LEAD

A 40 year old painter and decorator presented

with a 6 week H/O malaise, abdominal cramps,
nausea, arthralgia and mild mental impairment .
Though he had acquired a new respirator ,he did
not wear it, when other worker men were
burning off timber panelled walls in other room.

What is your diagnosis?

 Case 2 MERCURY
A 36 yr old woman presented to the OP with a
three day H/O abdominal pain, diarrhoea and
fever. One Week ago her daughter brought
mercury in liquid form from school and she
had put on heating stove .One day later, her
14 month old sister baby got fever and died.

What is your diagnosis?

 BY
GEETHIKHA B
LEAD AND
V SEMESTER
MERCURY
 OBJECTIVES
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 SOURCES OF LEAD
• Leaded paints and Drinking water-
Environmental and industrial exposure
PHARMACOKINETICS
  ACUTE LEAD POISONING
•Ingestion/inhalation
•Local action in mouth- astringency,
thirst, metallic taste
•Nausea
•Abdominal pain
•Vomiting
•Stool may be black from lead sulfide
•Acute hemolytic crisis
• Severe anemia
• Hemoglobinuria.
 CHRONIC LEAD POISONING
GI effects Neuromuscular

CNS Hematological

Renal Other
disturbances

10
 TREATMENT
-Initial t/t of lead intoxication-
supportive measures
-Prevention of further exposure
-Seizures are treated with diazepam
-Fluid & electrolyte balance must be maintained

Chelation therapy is indicated in symptomatic patients

or patients with blood lead concentration > 50-60µg/dl.
1) CaNa2EDTA
 Initiated at a dose of 30-50mg/kg per day
 deep i.m/slow i.v infusion

2) Dimercaprol
 4mg/kg i.m route every 4 hrs for 48 hrs
 Then every 6 hrs for 48 hrs finally every 6-12 hrs for additional
7 days.
3) D-Penicillamine
 Effective orally 250mg 4 times daily for 5 days
During chronic therapy – Not >40mg/kg per day.

4) Succimer
orally active
For children with safety & efficacy profile
10mg/kg every 8hrs for 5 days,then every 12hrs for
additional 2 weeks
 SOURCES
3 Chemical forms

Elemental mercury Salts of mercury Organic mercurials

 ABSORPTION GIT, Skin and
mucous
o n –
h a lati membranes
In
80% n 02
r p tio
abso 01 INORGANIC SALTS
OF MERCURY

03
ELEMENTAL
MERCURY

GIT
ORGANIC
MERCURIALS
 DISTRIBUTION
• Deposition in CNS,
Kidneys, liver and
spleen
• Methyl mercury –
Hair
• Within blood, methyl
mercury concentrates
more in RBC than in
plasma(10:1)
 EXCRETION
• Inorganic and elemental mercury is excreted –
Urine and feces (Body half life = 60 days)
• Organic mercury – fecal route (Body half life =
70 days)
MECHANISM OF ACTION
• Forms covalent bonds with sulfur
– Inactivates -SH groups of enzymes

Interfering with cellular metabolism and function

• Combines with phosphoryl, carboxyl, amide, and

amine groups
 ELEMENTAL MERCURY
• ACUTE
– Toxic to the lung – cough and
tightness in the chest
interstitial pneumonitis
– Weakness, chills, metallic taste,
nausea, vomiting, diarrhea
• CHRONIC
– CNS symptoms - tremors,
insomnia, memory loss, muscular
atrophy, weakness, paresthesia,
and cognitive deficits.
• Tachycardia, labile pulse, severe
salivation, and gingivitis
INORGANIC SALTS OF MERCURY
• Ashen-gray appearance of the mucosa of the mouth,
pharynx, and intestine

• Intense pain

• Systemic toxicity

• Severe hematochezia

• Renal toxicity (most serious and frequent systemic effect)

– Acute tubular necrosis
– Glomerular injury
ORGANIC MERCURIALS

• More neurological
effects
– Paresthesias
– Ataxia
– Visual Defects
– Dysarthria
– Hearing Defects
• Death
• Teratogenic effects
 TREATMENT
Inorganic and Elemental Mercury
– Dimercaprol 5 mg/kg i.m initially, followed by 2.5
mg/kg i.m every 12–24 hours for 10 days
– Penicillamine (250 mg orally every 6 hours) may
be used alone or following treatment with
dimercaprol
– Hemodialysis
 Organic Mercury
– Dimercaprol - contraindicated in methyl mercury
poisoning
– Penicillamine – Not efficacious
– Polythiol resin
– Conventional hemodialysis is of little value
• Infusion of L-cysteine into the arterial blood entering the
dialyzer
• Succimer - more effective than cysteine
REFERENCES