Náhodný nález olověných diabolek při rentgenovém vyšetření břicha

Title in English Accidental finding of lead pellets during abdominal X-ray


Year of publication 2021
Type Article in Periodical
Magazine / Source Pediatrie pro praxi
MU Faculty or unit

Faculty of Medicine

Web https://www.pediatriepropraxi.cz/artkey/ped-202106-0013_nahodny_nalez_olovenych_diabolek_pri_rentgenovem_vysetreni_bricha.php?back=%2Fsearch.php%3Fquery%3Dpape%25BE%26sfrom%3D0%26spage%3D30
Doi http://dx.doi.org/10.36290/ped.2021.092
Keywords lead intoxication; lead pellets; children
Description Lead belongs to heavy metals with a toxic effect on the human and especially children's organism. It is absorbed through the respiratory system or gastrointestinal tract. After binding to hemoglobin, it is deposited mainly in the bones, brain, kidneys, liver and skin. The half-life of lead in the blood is 30 days, with 80% excreted in the urine. However, it is eliminated from the bones for up to 10 years. Free lead inhibits enzymes involved in heme synthesis (5-ALA dehydrogenase, coproporphyrin oxidase, hemsynthetase). Acute lead intoxication is characterized by symptoms associated with gastrointestinal irritation (abdominal pain, vomiting, diarrhea). The symptomatology of chronic poisoning includes pale skin, fatigue, apathy, constipation, gray edging at the edges of the gums, diffuse colic-like abdominal pain (so-called saturnic colic). Laboratory examination of chronic intoxication reveals normochromic, normocytic anemia with basophilic erythrocyte spotting, elevation of liver transaminases and bilirubin, impairment of renal function. The level of lead in the blood together with the clinical condition of the affected individual will determine the management of the treatment of acute and chronic poisonings. It is recommended to examine children with levels of 200-440 µg / l or with a three-month persistence of levels of 150-190 µg / l on an outpatient basis, with the aim of finding and removing the source of lead. Treatment is necessary for children who have symptoms of poisoning, as well as for asymptomatic children with plumbemia above 450 µg / l, and if the source is not completely eliminated even at lower plumbemia (above 200 µg / l). Chelating antidotes are used for treatment, which bind lead ions with subsequent elimination of chelates by urine. EDTA (ethylenediaminetetraacetic acid) is available, DMSA (dimercaptosuccinic acid) is preferred in children.

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