铅中毒
发布于 2004-05-28 · 浏览 2690 · IP 江西江西
这个帖子发布于 20 年零 346 天前，其中的信息可能已发生改变或有所发展。
在香港急诊网看到 一份病例，觉得很好。贴上原帖：
A 30-year-old man with history of epilepsy and has regular FU in QEH. He was given Phenytoin and Valproate in the last couple of years.
He was admitted to UCH because of an epileptic attack in 4/2004. According to patient and his father, his drug compliance is good. He developed another episode of seizure after admission to the ward, lasted for 20 seconds. During the morning round, when I assessed him, it was just half an hour after his epileptic attack, he was conscious, but his response was slow. Initially, I suspected that he was having post-ictal drowsiness. However, this condition persisted and he was just like a mentally retarded patient, having very slow response to the extent that he still needed to think before he could tell me his name and his job.
Baseline investigations
1. Anaemia - haemoglobin 8.5 (normal Hb a few years ago) normochromic normocytic
2. impaired LFT, raised AST/ALT (hepatitis negative)
3. Phenytoin 1.2mg/L, Valproate 11mg/L
The anti-convulsant level was low, but he claimed that his drug compliance was good. He did lie to me and in fact, he took herbal medicine regularly instead of those drugs given from QEH. Another clue to arrive at the final diagnosis was that the CBP blood film showed basophilic stipplings (denatured RNA) in RBC. There are not much DDx for basophilic stippling. His blood lead level was sky high - 10.2umol/L (normal 0.2-0.7). He was suffering from lead toxicity. I got the blood film picture of this patient from my pathology colleagues and the picture file was attached. He also had the clinical sign of lead poisoning - lead line
From literature search, in the USA, the treatment for this patient with such high lead level should be EDTA/Dimercarpal. However, surprisingly when I contacted the pharmacy, the reply was that the stock of EDTA/dimercarpal in HA hospital was not even sufficient for the use of this patient in one day. We were forced to use Penicillamine which was abandoned in USA because of toxicity. What will be the consequence if this patient developed toxicity of Penicillamine?
Lead poisoning after taking Bao Ning Dan had been reported by TMH colleagues (H K Journal of Emergency Medicine Oct/Dec 2003). However, in that patient the lead level was just 3.03umol/L and she did not need chelation therapy. In fact, in my patient, after he was admitted, there was no more intake of those herbal medicine, and together with chelation therapy, his condition was markedly improved, in the sense that an improvement in mental function. He will be followed-up for his response to Penicillamine.
翻了一下：
30岁男性，有癫痫病史。在过去几年给予苯妥英钠和丙戊酸钠。
因癫痫发作于04年4月入院。据病人与其父之言，一直坚持服药。入院后再次发作，持续20秒。第二天早上在查房前半小时发作。查房时，病人意识清醒，但反应很慢。最初，我猜测是发作后的嗜睡。然而，这种情况持续，病人反应非常慢，像一个智力发育迟缓的病人。他要想一下才能告诉我自己的名字和工作。
1贫血，血红蛋白8.5（几年前正常），正常色素性红细胞。
2肝功能受损，AST/ALT升高，（肝炎阴性）
3苯妥英钠1.2mg/L,丙戊酸钠11mg/L.
抗癫痫药水平很低，但他声称坚持服了药，事实上他吃的是中草药而非这些药。。另一线索助于最终诊断，CBP血涂片示：红细胞嗜碱性点彩。病人的血铅水平非常高，10.2umol/L(正常0.2--0.7).最终诊断铅中毒。
（最后两段没翻，感兴趣的自己看看吧）
有两张图，嗜碱性点彩，铅线。太大，贴不上，建个链接。http://www.cem.org.hk/forum/viewtopic.php?t=2302
A 30-year-old man with history of epilepsy and has regular FU in QEH. He was given Phenytoin and Valproate in the last couple of years.
He was admitted to UCH because of an epileptic attack in 4/2004. According to patient and his father, his drug compliance is good. He developed another episode of seizure after admission to the ward, lasted for 20 seconds. During the morning round, when I assessed him, it was just half an hour after his epileptic attack, he was conscious, but his response was slow. Initially, I suspected that he was having post-ictal drowsiness. However, this condition persisted and he was just like a mentally retarded patient, having very slow response to the extent that he still needed to think before he could tell me his name and his job.
Baseline investigations
1. Anaemia - haemoglobin 8.5 (normal Hb a few years ago) normochromic normocytic
2. impaired LFT, raised AST/ALT (hepatitis negative)
3. Phenytoin 1.2mg/L, Valproate 11mg/L
The anti-convulsant level was low, but he claimed that his drug compliance was good. He did lie to me and in fact, he took herbal medicine regularly instead of those drugs given from QEH. Another clue to arrive at the final diagnosis was that the CBP blood film showed basophilic stipplings (denatured RNA) in RBC. There are not much DDx for basophilic stippling. His blood lead level was sky high - 10.2umol/L (normal 0.2-0.7). He was suffering from lead toxicity. I got the blood film picture of this patient from my pathology colleagues and the picture file was attached. He also had the clinical sign of lead poisoning - lead line
From literature search, in the USA, the treatment for this patient with such high lead level should be EDTA/Dimercarpal. However, surprisingly when I contacted the pharmacy, the reply was that the stock of EDTA/dimercarpal in HA hospital was not even sufficient for the use of this patient in one day. We were forced to use Penicillamine which was abandoned in USA because of toxicity. What will be the consequence if this patient developed toxicity of Penicillamine?
Lead poisoning after taking Bao Ning Dan had been reported by TMH colleagues (H K Journal of Emergency Medicine Oct/Dec 2003). However, in that patient the lead level was just 3.03umol/L and she did not need chelation therapy. In fact, in my patient, after he was admitted, there was no more intake of those herbal medicine, and together with chelation therapy, his condition was markedly improved, in the sense that an improvement in mental function. He will be followed-up for his response to Penicillamine.
翻了一下：
30岁男性，有癫痫病史。在过去几年给予苯妥英钠和丙戊酸钠。
因癫痫发作于04年4月入院。据病人与其父之言，一直坚持服药。入院后再次发作，持续20秒。第二天早上在查房前半小时发作。查房时，病人意识清醒，但反应很慢。最初，我猜测是发作后的嗜睡。然而，这种情况持续，病人反应非常慢，像一个智力发育迟缓的病人。他要想一下才能告诉我自己的名字和工作。
1贫血，血红蛋白8.5（几年前正常），正常色素性红细胞。
2肝功能受损，AST/ALT升高，（肝炎阴性）
3苯妥英钠1.2mg/L,丙戊酸钠11mg/L.
抗癫痫药水平很低，但他声称坚持服了药，事实上他吃的是中草药而非这些药。。另一线索助于最终诊断，CBP血涂片示：红细胞嗜碱性点彩。病人的血铅水平非常高，10.2umol/L(正常0.2--0.7).最终诊断铅中毒。
（最后两段没翻，感兴趣的自己看看吧）
有两张图，嗜碱性点彩，铅线。太大，贴不上，建个链接。http://www.cem.org.hk/forum/viewtopic.php?t=2302
最后编辑于 2004-05-28 · 浏览 2690
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