Occupational Diseases / / April 21, 2016
Lead - soft, gray metal.In nature, found mainly in the form of the mineral "galena" (lead sulphide).Litharge (lead oxide) - yellowish or reddish crystals.Lead minium (lead ortoplyumbat) - red crystalline powder.White lead - white amorphous powder.Lead sugar - a prism or plate.Lead vinegar - colorless crystals.
Paths lead intake of
Lead poisoning often occurs: when lead mining, smelting of lead and other metals from polymetallic lead-containing ores and the production of lead paint, batteries, some shops printing and cable production, hardening of metal products in lead baths, gas cutting metalparts painted with lead paint (red lead) and others.
in a production environment lead enters the body mainly through the respiratory system in the form of dust and fumes.Perhaps the ingestion of dust from the oral cavity (delivery with soiled hands while smoking and eating).Admission through the skin is possible, but of little practical value has not.
In everyday life the main source of lead poisoning are rar
Acute lead poisoning are rare.For chronic poisoning are characterized by the so-called cardinal signs: lead rim - dark gray or violet-slate narrow strip along the edge of the gums, especially in the front teeth (hematogenically failed lead is influenced by the existing mouth of hydrogen sulfide is converted to sulphide lead and deposited in the gingival region);Lead color - gray sallow complexion with a slight yellowness.Elevated blood levels of reticulocytes and red blood cells basophilic-grained;elevated urinary porphyrin and lead.
Lead circulates in blood in the form of finely divided colloidal albuminates phosphate and lead.Provided mainly through the colon and kidneys.It can be detected in all secretions (saliva, gastric juice, bile, breast milk).Urine OK - to 0.04-0.05 mg / l of lead;in feces - 2-3 times higher.Deposited mainly in the bones, and then in the liver, the kidneys.many years can be stored in the bones.In violation of the acid-base balance can come out of the bones in the form of readily soluble phosphate lead and again circulate in the blood.Such adverse effects may have an injury, infection, alcoholism.
Lead - protoplasmic poison broad-spectrum, is mainly changes in the nervous, cardiovascular system, blood;violation of enzymatic reactions involved in the synthesis of hemoglobin;exchange violation of the vitamin;reduction immunobiological reactivity of the organism.
Lead poisoning causes the following syndromes:
asthenovegetative syndrome occurs in the early stages of intoxication: weakness, fatigue, poor sleep, poor appetite, seizures, and paresthesias in extremities, sweating, pale skin, white or mixed dermographism,increased mechanical excitability of the muscles, hypotension, moderate bradycardia, lethargy, apathy.Usually the syndrome is associated with other symptoms of lead poisoning.In the absence of such poisoning can only be suspected.
Lead encephalopathy (in Russia is found only at the household poisonings) - organic diffuse brain damage: persistent headaches, especially in the occipital region, dizziness, weakness, memory loss, poor sleep, light scattered organic symptoms, lethargy,lethargy, sometimes combined with emotional lability, epileptiform seizures.
disorders of the peripheral nervous system
Motor polyneuritis paralysis of the extensor muscles ( "hanging brush," "hanging foot").Usually observed vegetative-sensitive polyneuritis (blurred pain, cyanosis or paleness of the hands and feet, their hypothermia, lowering the distal type of sensitivity), less animal-vegetative polyneuritis with blurred movement disorders (decrease in muscle tone in his arms and legs, decreased muscle strength, especiallyin the small muscles of the hands, lower heel - Achilles reflexes).
weakness, dizziness, asthenia.Pale skin, weight loss.Hypochromic anemia.Basophil-grained red blood cells more than 0.05% (the study of bright field), in severe cases - up to 1-2%.Purpurinuria.Reticulocytosis and coproporphyrinuria - early signs of intoxication, blood hemoglobin falls later.
in the bone marrow - mainly irritation erythroblastic germ with increased leaching of its elements.Increasing the number of reticulocytes, a significant amount of granular, basophilic erythrocytes.
syndrome Lack of appetite, nausea, constipation, a sweet taste in the mouth, abdominal pain, not related to food intake, cramping in nature.When fluoroscopy gastric peristalsis determined reinforced and accelerated the evacuation, the presence of "stage" of the stomach.At the height of the disease develop lead colic (rare in Russia): vomiting, sudden painful cramping in the abdomen;stomach in, pressure on the stomach several relieves pain, spastic constipation resistant to 10-14 days;sick tossing, moans, cries, can not find a comfortable position in bed;sweat, bradycardia, hypertension, anemia, lead;prolonged stasis in the small intestine, pyloric spasm.
Lead colic - pronounced vegetative crisis, which can trigger a variety of stressors: neuro-trauma, infection, alcoholism.Frequent diagnostic errors when colic is taken as "acute abdomen".Note working conditions, anamnesis, blood changes and other signs of toxicity, and some clinical features mentioned above.
functional liver failure - a violation protrombinoobrazovatelnoy (one of the early symptoms), pigment, protein synthesis and antitoxic functions of the liver.Liver plotnovata slightly increased.Partly ikterichnost sclera.Urobilinuria.Hepatitis occurs pas against common symptoms of lead intoxication, which gives an indication of its toxic nature.
syndrome Angiodistonicheskie phenomenon, retinal vascular spasm, spastic-atonic state of the capillaries.Lead promotes the development of Raynaud's syndrome and obliterating endarteritis.If early signs of intoxication - hypotension.Prolonged contact with lead - transient, then resistant hypertension.Often the development of essential hypertension as the long-term consequences of lead toxicity.There unfavorable course of essential hypertension in chronic poisoning.
Violations cholesterol metabolism
As early nonspecific reactions - reduction of bond strength between cholesterol and protein.Neurocirculatory metabolic disorders and promote early development of atherosclerosis (experimentally confirmed).Early cerebrovascular sclerosis;nephrosclerosis.There is a more severe atherosclerosis in lead poisoning.The long experience of work with lead relatively early development, unfavorable course, the presence of signs of intoxication (blood changes purpurinuria), lead the circulation in the body can serve as a criterion for determining professional etiology of the disease.Perhaps angina, myocardial infarction (on the basis of early atherosclerosis and coronary spasm), myocardial dystrophy.. Violation of the vitamin balance in the body - hypovitaminosis C, B1 and other endocrine disorders, "lead" bazedovizm (possible in the initial stages);menstrual disorders in women, possibly adverse effects on pregnancy and childbirth.
Biological addiction to lead is not observed.Repeated poisonings occur in a shorter time and occur usually heavier.There hypersensitivity to lead women and adolescents.
Individuals in contact with lead, especially suffered lead poisoning, occur as a manifestation of non-specific action of venom increased the incidence of influenza, sore throat, banal gastrointestinal diseases, activation of tuberculosis.
Classification of lead poisoning
1. Carriage lead - the presence of elevated amounts of lead in the urine, the presence of border in the absence of symptoms suggestive of poisoning.
2. Easy lead poisoning:
a) State, accompanied by certain symptoms of intoxication (reticulocytosis, increasing the number of red blood cells with basophilic stippling, an increase of porphyrin in the urine without any noticeable drop in hemoglobin percent;
b) asthenovegetative syndrome mild.
3. Lead poisoning moderate severity:
b) lead colic, mild expressed;
c) toxic hepatitis, symptomatic;
g) asthenic-vegetative syndrome;
d) sensitive form of polyneuritis.
4. Severe lead poisoning;
a) anemia (hemoglobin less than 50%);
b) lead colic (severe form);
g) lead paralysis.
syndromes on a background of chelating therapy.Chelators form with lead very stable compounds, can be easily removed by the kidneys.The most widely-tetatsin calcium and pentatsin.Tetatsin calcium administered intravenously with 20 ml of 10% solution in 200 ml of 5% glucose solution for 3 days (one per day) followed by a break for 3-4 days.2-4 Total cycle.Introduction tetatsina-calcium should be combined with the appointment of iron and vitamin B12.pentatsina treatment consists of two or three 3-day cycles intravenous infusions of 5 or 10% solution with 20 ml of 1 times a day with intervals between cycles of 5 days.
During treatment, patients must be transferred to work out of contact with lead.In the treatment of chelators should be considered contraindications (hemophilia, reducing blood clotting, hypocalcemia, liver disease and kidney).
During an exacerbation - products that contribute to lead Escrow (milk), without exacerbation - release (acid).As a preventive (neutralizes) the product is recommended the introduction of a diet of pectin (gelling agent) contained in large amounts in plant foods (apples, pears, apricots, beets, carrots, cabbage, etc..).Observations in humans have shown that regular cottage pectin (200 g salad of fresh cabbage and carrot) contributed to greater removal of lead and improve the general condition.
disability in carriers of lead - medical supervision.In mild poisoning appropriate treatment (preferably in a hospital), then transfer to another job (temporary) for 1-2 months.In the future, - medical supervision.By repeating the lung poisoning - permanent transfer to another job.
In moderately severe poisoning - treatment in the hospital.Provision of medical certificates for a period of 2 months, preferably followed by the addition of vacation.Spa treatment.Returning to work only when a full recovery.Medical supervision.At relapse, persistence or aggravation of intoxication - permanent employment - transfer to another job.
In severe poisoning - treatment in a hospital, in sanatorium conditions, compulsory transfer to another job without contact with the lead (as well as other toxic factors).
Replacing lead with less toxic substances.Sealing equipment, elimination of manual operations, effective local and general ventilation.Personal hygiene - a change of clothes, a shower, a meal in a particularly isolated areas.Remediation of the oral cavity.Preventive nutrition.Prohibition of teens working less than 18 years, the smelting of lead, its handling and soldering in the battery, etc. The prohibition of women's labor in a number of occupations where there is contact with molten lead.
During pregnancy and nursing women should be barred from working with lead.If there is a history of the data indicating persistent menstrual irregularities, inclination to miscarriages, - work with lead is absolutely contraindicated.