Vossoughinia Hassan, Pourakbar Ali, Esfandiari Samaneh, Sharifianrazavi Masoud
Associate Professor, Gastroenterology and Hepatology Department, Mashhad University of Medical Sciences, Mashhad, Iran.
Gastroenterology Fellow, Department of Gastroenterology and Hepatology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Middle East J Dig Dis. 2016 Jan;8(1):67-72. doi: 10.15171/mejdd.2016.10.
A 19-year-old woman was referred to the Emergency Surgery Department with severe abdominal pain, icterus, and anemia. The patient's clinical and paraclinical findings in addition to her occupational and social history, convinced us to assay blood lead level (BLL), which was 41/5 μg/dL. Therefore toxicology consult was performed to treat lead toxicity. Recheck of the BLL showed the level as 53/7 μg/dL. So oral chelator with succimer was started. Despite consumption of oral chelator, there was no response and the pain continued. Because our repeated evaluations were negative, we decided to re-treat lead poisoning by intravenous and intramuscular chelators. Dimercaprol (BAL) + calcium EDTA was started, and after 5 days, the pain relieved dramatically and the patient was discharged. We recommend more liberal lead poisoning therapy in symptomatic patients, and also suggest parenteral chelator therapy, which is more potent, instead of oral chelators in patients with severe symptoms.
一名19岁女性因严重腹痛、黄疸和贫血被转诊至急诊外科。患者的临床和辅助检查结果，以及其职业和社会史，促使我们检测血铅水平（BLL），结果为41/5μg/dL。因此，我们进行了毒理学咨询以治疗铅中毒。复查BLL显示该水平为53/7μg/dL。于是开始使用口服螯合剂二巯基丁二酸。尽管服用了口服螯合剂，但没有效果，疼痛仍持续。由于我们的多次评估均为阴性，我们决定通过静脉和肌肉注射螯合剂重新治疗铅中毒。开始使用二巯丙醇（BAL）+ 依地酸钙钠，5天后，疼痛显著缓解，患者出院。我们建议对有症状的患者采取更积极的铅中毒治疗方法，并且还建议在症状严重的患者中采用更强效的胃肠外螯合剂治疗，而非口服螯合剂。
