Background Lead poisoning has been reported infrequently in recent years in developed countries due to the implementation of legislative measures aimed at reducing environmental lead. The few cases that appear correspond mainly to occupational exposure.
Purpose To describe the therapeutic management in a case of chronic lead poisoning.
Material and methods The case was a 53-year-old man, dedicated to the exploitation of lead in an abandoned mine. He attended the internal medicine unit for joint pain, dyspnoea with minimum–moderate effort, asthenia and dysthermia sensation and scarce cough. He also had dark urine, abdominal pain, nausea, vomiting and unquantified weight loss. Background: dyslipidaemia and 30 cigarettes/day. Analytical data included: haemoglobin (Hb) 8.2 g/dL, haematocrit (HCT) 25.1%, peripheral blood smear with anisocitosis, rounded red spherocyte-like cells, elements with basophilic stippling, plasma creatinine (Cr) 0.67 mg/dL, glomerular filtration 109.7 mL/min/m2, urobilinogen in urine 8 mg/dL, blood lead 946 μg/dL and urinary lead excretion 2024 μg/24 hours. He was diagnosed with haemolytic anaemia for lead poisoning and the clinic contacted the pharmacy department for pharmacotherapy management. A conservative approach was adopted due to few cases with lead blood levels above 100 μg/dL in the literature, and the patient had no neurological symptoms despite levels higher than 900 μg/dL.
Results Hospitalisation for chelation therapy was decided, consisting of intramuscular dimercaprol 200 mg every 4 hours on day+1 and day+2, every 6 hours on day+3 and day+4 and every 12 hours on day+5, with EDTA calcium 1500 mg every 12 hours administered for 6 hours, with the first dose administered 4 hours after intramuscular administration of dimercaprol. As premedication, he was given 1 vial of dexclorfeniramina every 8 hours and 500 mL bicarbonate 1/6 molar every 12 hours. Analytical results during treatment were: Cr 0.59, 0.84, 0.55, 0.71, 0.48, 0.54; Hb 7.6, 9.6, 10.9, 8, 9. 1, 8.6, 9; HCT 23.1, 29.1, 32.9, 24.5, 28.5, 25.3, 27.7. The clinical course was satisfactory, without deterioration of renal function and no complications due to chelation therapy. 1 month after the chelating treatment, lead analytical results were: blood lead 70 μg/dL, urinary lead excretion 162 μg/24 hours.
Conclusion Chronic lead poisoning is unusual. The pharmacological management is generally little known and there is no clear consensus in the literature, requiring a multidisciplinary team to address the situation. Pharmacists play an essential role in the acquisition, management, dispensation and validation of the treatment, to achieve the therapeutic goal in the shortest time and with an optimum result.
References and/or acknowledgements Fernández-Fernández FJ, et al. Intoxicación crónica por plomo. An Med Interna (Madrid) 2002;19:130–2.
No conflict of interest
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