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CLINICAL TOXICOLOGY > HEAVY METAL POISONING > Flashcards

HEAVY METAL POISONING Flashcards

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1
Q

Specific gravity of heavy metals in their standard state

A

Above 5g/cm3

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2
Q

Which heavy metals are released into water by industrial and domestic waste

A

Pb
Hg
As
Cd

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3
Q

Long term use of fertilizers lead to accumulation of which heavy metal

A

Cd

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4
Q

Sewage or sludge application releases which heavy metals

A

Hg
Cd

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5
Q

Dust from smelters, industrial waste and bad agricultural watering practices contaminate agricultural lands with which heavy metals

A

Hg
Cd
As
Pb

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6
Q

How are plants contaminated by heavy metals

A

Fertilizers/Pesticides/Insecticides

Plants growing in soil contaminated area

Irrigation of crops with contaminated water

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7
Q

Plants method for detoxification of heavy metals is is mainly based on ————-//

A

Chelation subcellular compartmentalization

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8
Q

Five processes of phytoremediation

A

Rhizodegradation
Rhizofiltration
Phytoextraction/ Phytoaccumulation
Phytovolatilization
Phytostabilization

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9
Q

Examples of toxic metals that have no know beneficial effects in organisms

A

Plutonium
Lead

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10
Q

Most hazardous heavy metals that humans are exposed to

A

As, Pb, Hg, Cd, Fe and Al

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11
Q

Factors that affect toxicity of heavy metals

A

Dose absorbed
Exposure was acute or chronic
Age of the person

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12
Q

Why are young children more susceptible to effects of lead exposure

A

Their brains are more plastic and even brief exposures can influence developmental processes

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13
Q

Major sources of arsenic and mercury indoors

A

Pesticides and Fungicides

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14
Q

Methods for measuring trace metals

A

Atomic absorption spectrophotometry -destructive , sample should be in solution

X-ray fluorescence - nondestructive , sample can be in any state

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15
Q

Easiest screening process for heavy metal
Poisoning

A

Hair analysis

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16
Q

Steps involved in treating heavy metal poisoning

A

Decontamination
Resuscitation
Chelation

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17
Q

Toxicity of EDTA

A

Hypocalcémic tetany
Hydropic vacuolization of the proximal tubule
Loss of the brush border
Degeneration of proximal tubules

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18
Q

Why is mercury unavailable to EDTA

A

Tightly bound by sulfhydryl groups or sequestered in body compartments that are not penetrated by EDTA

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19
Q

Does EDTA penetrate cells

A

It does not significantly penetrate cells hence has a volume of distribution approximating ECF space

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20
Q

Disadvantage of DTPA

A

Depletes Zn
Teratogenic lime EDTA due to its Zn and Mn depletion effect
Limited access to intracellular sites

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21
Q

Which solvent is used for Dimercaprol

A

Peanut oil due to its instability in aqueous solutions

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22
Q

Why is Dimercaprol nephrotoxic

A

Sulfur-metal bond is unstable labile in acidic tubular urine increasing delivery of metal to renal tissue and increase toxicity

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23
Q

Another name for Dimercaprol

A

British Antilewisite BAL

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24
Q

Chelators used in Treatment of lead encephalopathy in due to lead poisoning

A

Dimercaprol + CaNa2EDTA

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25
Route of administration of dimercaprol
Deep Intramuscular injection as 100mg/ml solution in peanut oil
26
Toxicity of dimercaprol
Hypertension Tachycardia
27
Difference between succimer and dimercaprol
Succimer has two carboxylic groups hence has less lipid solubility
28
Desirable features of succimer
Does not significantly mobilise essential such as Zn, Cu and Fe
29
Difference between toxicity of dimercaprol and succimer
Succimer is less toxic due to its lower lipid solubility which minimizes cellular penetration
30
Why is n acetyloenicillamine more effective than penicillamine for mercury toxicity
More resistant to metabolism
31
Toxicity of penicillamine
Cutaneous lesions Urticaria Macular or papular reactions Pemphigoid lesions Lupus Dermatomyositis Adverse effects on collagen
32
Which chelator has prooxidant effects
DTPA
33
Aerobic bacteria involved in bioremediation
Mycobacterium Sphingomonas Alcaligenes Rhodococcus Pseudomonas
34
Examples of hyperaccumulator plant species
Avena spp Brassica spp
35
Commonest source of acute metal poisoning
Arsenic
36
Least toxic form of arsenic
Elemental arsenic
37
Most popular homicidal poison
Arsenic
38
Why is arsenate less toxic than arsénite
It is has less water solubility
39
Most toxic form of arsenic
Arsine gas ( 25-30ppm) can be lethal in 30mins
40
Toxic dose of arsenic trioxide
200-300mg
41
Routes of absorption of arsenic
All routes
42
Effect of arsenic on bone
Replaces phosphorus in bone
43
Does arsenic cross the BBB
No
44
Teratogenic effects of arsenic
Intrauterine death of the fœtus Or Respiratory distress in less severe cases
45
How does arsenic cause respiratory distress in the fœtus
Pulmonary hemorrhage and hyaline membrane formation
46
Three clinical forms of arsenic poisoning
Acute fulminating type Subacute type( gastroenteritis type) Chronic type
47
Effects of acute arsenic toxicity
Capillary dilatation Myocardial failure Shock Death
48
Mechanism of acute arsenic toxicity
Acts on sulfhydryl groups of enzymes and capillaries and inhibit cellular metabolism
49
Symptoms of sub acute type arsenic poisoning
Resembles cause of food poisoning or cholera
50
Five manifestations of chronic type arsenic toxicity
Gastrointestinal Catarrhal Raindrop pigmentation Mees lines Arsenic neuritis
51
Gastrointestinal symptoms of arsenic toxicity
Gradual weight loss Malnutrition Fatigue Loss of appetite
52
Catarrhal symptoms of chronic arsenic toxicity
Running nose Headache Conjunctivitis Bronchial catarrh
53
Raindrop pigmentation
Milk and roses pigmentation followed by brown patchy pigmentation of the skin
54
Mees lines
Whitish lines across the nails of the fingers and toes
55
Symptoms of arsenic neuritis
Polyneuritis Optic neuritis Paraesthesias Atrophy of extensors regulating in wrist and food drop
56
Diagnosis of chronic arsenic toxicity
Urinary As level > 100mg/24 hours
57
Which metal poisoning causes garlic steel to breath and tissue fluids
Arsenic
58
Manifestations of arsine gas exposure
Acute hemolytic anemia and striking chills
59
Most common neurological effect of chronic arsenic intoxication
Sensory predominant peripheral neuropathy in a stocking glove pattern
60
Types of skin reactions caused by arsenic dust
Toxic Eczematous Combined toxic and eczematous Follicular lesions
61
Describe the classical dermatitis caused by chronic arsenic toxicity
Hyperkeratosis with a classical dew drops on a dusty road appearance
62
Diagnosis of arsenic toxicity
Urine level Blood level Hair level Radiography
63
Levels of arsenic in urine which indicate toxicity
24hr excretion more than 100mcg/L
64
Metabolites of arsenic
Methylarsonic acid Dimerhyarsenic acid
65
Chelation therapy for arsenic
Dimercaprol Penicillamine DMPS and DMSA are superior
66
Which urine urine level of arsenic in an asymptomatic patient prompts chelation
200mcg/L
67
Most commonest metal involved in chronic poisoning
Lead
68
Forms of lead and uses
Lead acetate - therapeutics Lead carbonate(white lead)- paints Lead oxide (litharge)- glazing of pottery and enamel ware Tetraethy lead - mixed with petrol as an antiknock Lead tetraoxide - vermillion Lead sulfide- collyrium (surma)
69
Routes of absorption of lead
All portals of entry
70
Which form of lead can be absorbed directly through the skin
Tetraethyl lead
71
Route of Occupational exposure to lead
Inhalation
72
Routes of excretion lead
Urine and Bile
73
Mode of action lead
Inhibits sulfhydryl enzymes Decreases heme synthesis Increases hemolysis Edema in CNS Affects CVS
74
Enzymes Involved in heme synthesis that are affected by lead
Aminolaevulinic acid synthetase Aminolaevulinic acid dehydrase Ferrochelatase Corporphyrinogen oxidase
75
Effects of lead on CVS
Hypertension and Myocarditis
76
In what forms is lead stored in bones
As phosphate and carbonate
77
Effect of lead on kidney
Nephritis
78
What is plumbism
Lead toxicity
79
What is the burton line or gingival lead line
Dark blue line along the gums that signify lead poisoning
80
Management of cerebral edema in lead poisoning
Mannitol Or Glycerol Dexamethasone
81
Management of seizures in lead encephalopathy
Diazepam

CLINICAL TOXICOLOGY (14 decks)

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