11/66. The interpretation of zinc protoporphyrin changes in lead intoxication: a case report and review of the literature.BACKGROUND: zinc protoporphyrin (ZPP) has been used both as a screening and diagnostic test for overexposure to lead for nearly 30 years, although limitations for both purposes are recognized. methods: We present longitudinal findings for ZPP and whole-blood lead in a man with two episodes of acute lead intoxication and review the literature on the use of ZPP. RESULTS AND CONCLUSIONS: ZPP elevations in both chronic and acute exposure settings lag behind elevations in whole-blood lead by approximately 8-12 weeks. Therefore, ZPP measurement, in conjunction with whole-blood lead determination, has clinical utility in cases of substantial overexposure by providing information on how long an individual may have been overexposed to lead. A guide to the interpretation of various combinations of whole-blood lead and ZPP results is provided. However, while ZPP levels do correlate with whole-blood lead measurements in aggregate, the considerable individual variability of ZPP measurements, poor sensitivity at lower ranges of lead exposure, poor specificity and delayed changes in unstable exposure conditions indicate that this test contributes little to screening programs. Finally, our results confirm that basophilic stippling is seen in acute as well as chronic lead intoxication, and may provide the first indication of lead intoxication.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
12/66. Neuropsychologic and postural sway improvement after Ca( )-EDTA chelation for mild lead intoxication.Neuropsychologic and postural sway test performance improved following Ca( )-EDTA chelation in a bridge worker with persistent central nervous system (CNS) symptoms 2 years after an episode of subacute lead intoxication. This case highlights the value of these tests in verifying symptoms and documenting response to therapy. Persistent disabling CNS symptoms with objective neuropsychologic deficits was unexpected, given the borderline total body lead burden.- - - - - - - - - - ranking = 0.71428571428571keywords = intoxication (Clic here for more details about this article) |
13/66. Effective treatment of manganese-induced occupational Parkinsonism with p-aminosalicylic acid: a case of 17-year follow-up study.OBJECTIVE: Chronic manganese (Mn) intoxication induces syndromes resembling parkinson disease. The clinical intervention has largely been unsuccessful. We report a 17-year follow-up study of effective treatment of occupational Mn parkinsonism with sodium para-aminosalicylic acid (PAS). methods: The patient, female and aged 50 at the time of treatment, was exposed to airborne Mn for 21 years (1963-1984). The patient had palpitations, hand tremor, lower limb myalgia, hypermyotonia, and a distinct festinating gait. She received 6 g PAS per day through an intravenous drip infusion for 4 days and rested for 3 days as one therapeutic course. Fifteen such courses were carried out between March and June 1987. RESULTS: At the end of PAS treatment, her symptoms were significantly alleviated, and handwriting recovered to normal. Recent follow-up examination at age 67 years (in 2004) showed a general normal presentation in clinical, neurologic, brain magnetic resonance imaging, and handwriting examinations with a minor yet passable gait. CONCLUSIONS: This case study suggests that PAS appears to be an effective drug for treatment of severe chronic Mn poisoning with a promising prognosis.- - - - - - - - - - ranking = 0.14285714285714keywords = intoxication (Clic here for more details about this article) |
14/66. Axonal polyneuropathy after acute dimethylamine borane intoxication.OBJECTIVE: To study a patient with axonal polyneuropathy due to acute dimethylamine borane (DMAB) intoxication. PATIENT: confusion and drowsiness in the acute stage, followed by cognitive impairments and polyneuropathy, are reported in a chemical factory worker after acute exposure to DMAB. RESULTS: Nerve conduction studies indicated axonal polyneuropathy, particularly in the motor nerves. sural nerve biopsy studies 3 months later revealed an axonal degeneration with a mild decrease of fiber density in the large myelinated fibers. Quantitative sensory testing also disclosed an impairment of pinprick, temperature, and touch sensations. Cutaneous nerve biopsy studies 9 months later demonstrated a moderate loss of epidermal nerves. During the follow-up period of 1.5 years, the clinical features and serial nerve conduction studies showed a steady improvement. CONCLUSIONS: Since DMAB is a new product and has been widely used recently in the manufacturing of semiconductors and electronics, we conclude that DMAB intoxication may produce motor-predominant axonal polyneuropathy and that the establishment of a threshold limit value is warranted.- - - - - - - - - - ranking = 0.85714285714286keywords = intoxication (Clic here for more details about this article) |
15/66. Chronic neuropsychological and neurological impairment following acute exposure to a solvent mixture of toluene and methyl ethyl ketone (MEK).A 38 year-old laborer experienced solvent intoxication during each of two spray paintings of a dump truck and other heavy equipment in an enclosed, unventilated garage. The paint base consisted primarily of toluene and methyl ethyl ketone. nausea, headaches, dizziness, respiratory difficulty and other symptoms began after exposures. Over the next several days he developed impaired concentration, memory loss and cerebellar signs including an intention tremor, gait ataxia and dysarthria. MRI of the brain and EGG early in the work-up were normal, although later MRIs demonstrated fluid collection over the left parietal area. Examination by a toxicologist and neurologist revealed likely toxic encephalopathy with dementia and cerebellar ataxia. Three formal neuropsychological assessments over 2 1/2 years quantified cognitive, motor and behavioral changes. Despite similar findings in chronic exposure to these solvents, lasting sequelae following acute exposure have not been widely reported.- - - - - - - - - - ranking = 0.14285714285714keywords = intoxication (Clic here for more details about this article) |
16/66. adult chronic lead intoxication. A clinical review.A stained-glass artisan with depression and a retired junkyard worker with congestive cardiomyopathy had increased mobilizable body burdens of lead by calcium ethylenediaminetetaacetic acid testing. Although both patients improved with several months of intramuscular chelation therapy, the efficacy of such therapy in chronic lead poisoning is controversial. Recognition of unusual manifestations of chronic lead poisoning may at least interrupt further exposure, even if specific therapy is not undertaken.- - - - - - - - - - ranking = 0.57142857142857keywords = intoxication (Clic here for more details about this article) |
17/66. Ten cases of acute lead intoxication among bridge workers in louisiana.We report the cases of ten construction workers who developed acute lead intoxication while repairing a bridge in louisiana. All but one patient received a five-day course of edetate calcium disodium (calcium EDTA) chelation therapy; one patient received five doses instead of five days of treatment. calcium EDTA 25 mg/kg q12h was administered for ten consecutive doses by intravenous infusion over two hours. Each dose was diluted in NaCl 0.9% 500 mL. No adverse drug effects were observed during treatment. The posttreatment mean whole blood lead (PbB) concentration was significantly reduced compared with the pretreatment mean PbB (1.48 /- 0.70 vs. 3.8 /- 1.68 mumol/L; p = 0.0012, Student's paired t-test). This indicates that the body lead burden of these patients was effectively reduced with calcium EDTA. Eight patients had complaints on admission that were suggestive of lead intoxication. These included malaise, numbness of the extremities, arthralgia, myalgia, abdominal discomfort, sleep disturbance, and lower back pain. patients had no complaints on discharge. Eight patients had mild anemia that was consistent with acute lead intoxication (mean pretreatment hemoglobin ( /- SD), 128.6( /- 17.2 g/L), but calcium EDTA therapy did not appear to effect any change in the pretreatment hemoglobin values. The Occupational safety and health Administration (OSHA) lead standard requires that manufacturers provide employees at risk for occupational lead exposures with proper respirators and medical surveillance to prevent lead intoxication. The construction industry is exempted from these standards except in maryland. We believe that amendment of the OSHA lead standards, to provide specific lead regulation of the construction industry, would be helpful in preventing similar cases of occupational lead intoxication.- - - - - - - - - - ranking = 1.2857142857143keywords = intoxication (Clic here for more details about this article) |
18/66. Cerebellar lesion, polyneuropathy and mental dysfunction in a seaman working on chemical tankers.A seaman with symptoms and signs from the nervous system was examined. He had symptoms and signs of affection of his mental status, cerebellum and peripheral nerves. He had been working on tankers for 31 years, and had regularly been exposed to different organic solvents during loading, unloading and cleaning of the tanks. As no other disease was present in this patient, the existence of a chronic organic solvent intoxication syndrome was suggested.- - - - - - - - - - ranking = 0.14285714285714keywords = intoxication (Clic here for more details about this article) |
19/66. Acute water intoxication as a complication of urine drug testing in the workplace.urine drug testing is now mandatory in many industries. We report the first case, to our knowledge, of an adverse consequence of drug testing in the workplace: acute water intoxication. We discuss normal water metabolism and the adverse effects of water loading and impaired renal function on free water clearance. We present a literature review of seven other cases of acute voluntary water intoxication in patients without chronic psychiatric or neurologic illness. For workers undergoing urine drug testing we conclude that risk factors for acute water intoxication include (1) intake of more than 1 L of water and (2) impaired urine dilution. In a recently drug-tested worker, symptoms of cerebral dysfunction should suggest the possibility of water intoxication.- - - - - - - - - - ranking = 1.1428571428571keywords = intoxication (Clic here for more details about this article) |
20/66. Telencephalic dysgenesis associated with presumptive maternal carbon monoxide intoxication in the first trimester of pregnancy.We report the association of telencephalic dysgeneses (expected to occur around week 6 of gestation) with presumptive maternal carbon monoxide intoxication. This case supports the hypothesis that carbon monoxide intoxication at critical periods of human brain development may lead not only to decreased brain size and hypoxic-ischemic lesions, but also to dysgeneses.- - - - - - - - - - ranking = 0.85714285714286keywords = intoxication (Clic here for more details about this article) |
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