George Mathew, Heeney Matthew M, Woolf Alan D
Harvard Medical Toxicology Program, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatr Emerg Care. 2010 May;26(5):370-3. doi: 10.1097/PEC.0b013e3181db2237.
Acute encephalopathy from childhood lead poisoning is fortunately rare. However, in pediatric patients with developmental disabilities and pica, there is a risk of lead exposure at a dose commensurate with encephalopathy, coupled with a risk of delayed diagnosis because of difficulty in distinguishing between baseline and altered behavior. We report here a 4-year old autistic boy who presented to the pediatrician's office with gastrointestinal symptoms and behavioral changes and was at first thought to have a viral syndrome. He returned 2 days later with a worsening illness; increasing pallor, vomiting, abdominal colic, and changes in consciousness were recognized in the emergency department as lead-induced anemia and encephalopathy, associated with a positive abdominal film for paint chips and a blood lead level equal to 216 microg/dL (10.43 micromol/L) (reference, <10 microg/dL or 0.483 micromol/L). As this case illustrates, prompt recognition is dependent on the skills and suspicions of an astute clinician, especially in the busy emergency department.
儿童铅中毒所致的急性脑病所幸较为罕见。然而，对于患有发育障碍和异食癖的儿科患者，存在接触铅剂量达到可引发脑病程度的风险，同时由于难以区分基线行为与行为改变，存在诊断延迟的风险。我们在此报告一名4岁自闭症男孩，他因胃肠道症状和行为改变前往儿科医生办公室就诊，最初被认为患有病毒综合征。两天后他病情加重返回；在急诊科，面色苍白加重、呕吐、腹部绞痛和意识改变被诊断为铅中毒性贫血和脑病，同时腹部X线片显示有油漆碎片阳性，血铅水平为216微克/分升（10.43微摩尔/升）（参考值，<10微克/分升或0.483微摩尔/升）。正如本病例所示，及时识别取决于敏锐临床医生的技能和怀疑意识，尤其是在繁忙的急诊科。
