toxins

Question 1

LED POISONING

Answer 1

can produce dysfunction of both the central and peripheral nervous systems.
In children - acute encephalopathy is the major neurologic feature.

peripheral neuropathy is predominantly motor,     
     #more severe in the arms than in the legs. 
     #asymmetric progressive motor disturbance. 
     #Sensory loss is usually inconspicuous or absent.        
      #loss or depression of tendon reflexes. 

Systemic manifestations:
     #anemia, #constipation, #colicky abdominal pain,       #gum discoloration, #nephropathy. 

optimal treatment is not known,
- IV EDTA, oral penicillamine, dimercaprol (BAL).

Question 2

PARALYTIC SHELLFISH POISONING

Answer 2

Sensory and motor nerve action potential block

rapidly progressive acute peripheral neuropathy, with sensory symptoms and a rapidly ascending paralysis, begins within 30 minutes after eating affected shellfish
may lead to respiratory paralysis and death.
no available antitoxin,
with proper supportive care (including mechanical ventilation if necessary) the patient recovers completely. A cathartic or enema may help remove unabsorbed toxin.

Question 3

PORPHYRIA (386/733)
clincal pathway
clinical symptoms

Answer 3

בעיה כבדית מורשת
נגרם בגלל תרופות, צום, זיהום או הריון
בערך שבועיים
כאבי בטן, דליריום, נוירולוגי
נוירולוגי - חולשה סימטרית פרוקסימלית, מתפשטת עד קוודריפלגיה.
יכול להיות פגיעה תחושתית

hereditary hepatic porphyrias.
Attacks can be precipitated by drug, infection, a period of fasting, or, occasionally, menses or pregnancy.
last for 1 to 2 weeks
can be life-threatening.

Colicky abdominal pain—sometimes also felt in the back or thighs—frequently precedes neurologic involvement, and there may also be anxiety, agitation, acute confusion or delirium, and convulsions.

symmetric proximally Weakness is the major neurologic manifestation
may begin in the upper limbs and progress to involve the lower limbs or trunk.
can lead to complete flaccid quadriparesis with respiratory paralysis over a few days.

Sensory loss occurs also but is less conspicuous and extensive;
muscle pain is sometimes prominent.
tendon reflexes may be depressed or absent.

Acute attacks may be accompanied by fever, excessive sweating, persistent tachycardia, hypertension, hyponatremia

Question 4

ACUTE ARSENIC OR THALLIUM POISONING

Answer 4

rapidly evolving sensorimotor polyneuropathy, often with an accompanying or preceding gastrointestinal disturbance and crampy abdominal pain. 
#skin rash, with increased skin pigmentation and marked exfoliation, 
#Mees lines (transverse white lines) on the nails in long-standing cases. 
#hair loss. 

Sensory symptoms - often painful, are usually the earliest manifestation of polyneuropathy;
followed by symmetric motor impairment, - distal, in the legs

The degree of neurologic recovery depends on the severity of the intoxication.

Question 5

ORGANOPHOSPHATE POLYNEUROPATHY

Answer 5

1. initial symptom - Cramping muscle pain in the legs
2. paresthesias. Progressive leg weakness then occurs, along with depression of the tendon reflexes.
3. Sensory disturbances also develop in some instances, initially in the legs and then in the arms, but these disturbances are often mild or inconspicuous.