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Flashcards in Heavy Metal Deck (32)
1

lead distribution

about 99% of lead in the bloodstream binds
to hemoglobin in erythrocytes; only around 1% is available to
the tissues; initially, lead is distributed to soft tissues (tubular
epithelium of the kidney and liver), but in time the lead is
redistributed and deposited mostly in bone but also in teeth
and hair

2

lead symptoms

a. GI: GI effects are an early warning sign of lead exposure;
anorexia, muscle discomfort, malaise, and headache;
constipation; a persistent metallic taste; lead colic (severe
abdominal pain)
b. neuromuscular: lead palsy or neuromuscular syndrome is
rare in the U.S.; muscle weakness (wrist-drop and foot-drop)
and fatigue occur long before paralysis
c. CNS: lead encephalopathy; is the most serious manifestation
of lead poisoning and more common in children; early signs
are clumsiness, vertigo, ataxia, falling, headache, insomnia,
restlessness, and irritability; later, delirium, tonic-clonic
convulsions, and coma follow; may be a progressive mental
deterioration in children

3

lead hematological

blood lead concentration of 80 g/dl
causes basophilic stippling (aggregated RNA) but is not
pathognomonic of lead poisoning; hypochromic microcytic
anemia is more common and reflects a decreased life span of
the erythrocytes and an inhibition of heme synthesis
e. renal: less dramatic than the CNS or GI effects
Lead lines: long bones on X-ray

4

lead- what accumulates in blood

delta-aminolevulinate (delta-ALA)- second step in heme synthesis is blocked by lead
protoporph accumulates in blood

5

lead chelators

1) Dimercaprol, 2) Succimer
(kids), 3) EDTA and 4) penicllamine

6

mercury

dental amalgams & fish (methylmercury)

7

organic mercury

organic mercurials are more completely absorbed (90%)
from the GI tract than inorganic mercury salts; the primary
concentration is in erythrocytes and hair; t1/2 is 45-105 days
organic can cross BBB & placents

8

mercury is similar to ...

methionine- can go thro aa transporters in the body

9

mercury symptoms

neurological

10

mercury treatment

polythiol resin

11

target for arsenic

sulfhydryol groups- will be found in high levels in hair and nails

12

arsenic half life

short compared to other metals bc it is metabolized by glutathione

13

chronic arsenic poisoning

a. early signs are muscle weakness and aching, skin
pigmentation (eyelids, neck, nipples and axillae)
b. less prominent GI effects; garlic odor of the breath and
perspiration

14

arsenic treatment

dimercaprol

15

cadmium half life

the half life is 10-30 years

16

chronic cadmium poisoning

kidney: cadmium combines with glutathione and with
metallothionine (brings it to the kidney); effects are mainly on the proximal tubule
cells
cancer: tumors of the lung, prostate, kidney and stomach
have been reported from workers exposed occupationally
to cadmium

17

iron poisoning symptoms

only one im worried about acute poisoning
a. occur within 30 min.
b. abdominal pain, diarrhea, brown and bloody vomitus;
pallor or cyanosis, drowsiness, hyperventilation,
cardiovascular collapse
c. death within 6 hrs or 12-24 hrs

18

iron treatment

deferoxamine

19

penicillamine

for copper poisoning- wilsons disease
trientine is alternatiev

20

what will flush iron pills

sorbitol

21

acetaminophen

acetylcysteine

22

anticholinesterases: organophosphates, carbamates

atropine

23

TCAs, quinidine

bicarb, sodium

24

fluoride, CCBs

calcium

25

theophylline, caffeine, metaproterenol

esmolol

26

benzos

flumazenil

27

methanol, ethylene glycol

alcohol
fomepizole- long acting

28

B- blockers

glucagon

29

opioids

naloxone

30

carbon monoxide

oxygen

31

antimuscarinic blockers

phyostigmine

32

organophosphates cholinesterase inhibitors

Pralidoxime (2-PAM)