罕见的因意外或慢性职业性接触铅和锰而导致的严重威胁生命的铅中毒病例：诊断、治疗和预后。
Rare cases of severe life-threatening lead poisoning due to accident or chronic occupational exposure to lead and manganese: Diagnosis, treatment, and prognosis.
机构信息
Department of Occupational Medicine and Toxicology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
138262School of Health Sciences, Purdue University, West Lafayette, Indiana, USA.
出版信息
Toxicol Ind Health. 2020 Dec;36(12):951-959. doi: 10.1177/0748233720958969. Epub 2020 Oct 23.
BACKGROUND
Chronic long-term, low-dose environmental and occupational exposure to lead (Pb) has been extensively studied in large cohorts worldwide among general populations, miners, smelters, or battery workers. However, studies on severe life-threatening Pb poisoning due to accidental or chronic occupational exposure to Pb and manganese (Mn) were rarely reported.
METHODS
We present one case of acute severe Pb poisoning and compare it with another severe chronic occupational exposure case involving Pb and Mn. A 27-year-old woman mistakenly took a large quantity of pure Pb powder as an herbal remedy; she developed abdominal colic, severe nausea, vomiting, fatigue, and cutaneous and sclera icterus. Laboratory tests showed her blood lead level (BLL) of 173.5 µg dL and urinary lead level (ULL) of 1240 µg dL. The patient was diagnosed with acute Pb poisoning and acute liver failure. In another chronic exposure case, a 56-year-old man worked in a Pb and Mn smelting factory for 15 years. He was brought to the emergency room with severe nausea, vomiting, and paroxysmal abdominal colic, which was intolerable during the onset of pain. His BLL was 64.8 µg dL and ULL was 38 µg dL, but his blood and urinary Mn levels were normal. The patient was diagnosed with chronic Pb poisoning. Both patients received chelation therapy with calcium disodium ethylene-diamine-tetraacetate (CaNaEDTA). The woman with acute severe Pb intoxication recovered well and was discharged from the hospital after treatment, and the man who survived severe Pb poisoning was diagnosed with lung cancer.
CONCLUSION
Clinical manifestations of acute and chronic severe Pb poisoning are different. Chelation therapy with CaNaEDTA is proven to be an effective life-saving therapy in both cases by reducing BLL. Occupational exposure to both Pb and Mn does not appear to increase Mn neurotoxicity; however, the probability that co-exposure to Mn may increase Pb toxicity in the same patient cannot be excluded.
背景
在全球范围内的普通人群、矿工、冶炼厂或电池工人中，已经对慢性长期、低剂量的环境和职业性铅（Pb）暴露进行了广泛的研究。然而，由于意外或慢性职业性接触 Pb 和锰（Mn）而导致的严重危及生命的 Pb 中毒的研究却很少报道。
方法
我们报告了一例急性重度 Pb 中毒病例，并将其与另一例涉及 Pb 和 Mn 的严重慢性职业性暴露病例进行了比较。一位 27 岁的女性误将大量纯 Pb 粉末当作草药服用；她出现了腹部绞痛、严重恶心、呕吐、乏力以及皮肤和巩膜黄疸。实验室检查显示她的血 Pb 水平（BLL）为 173.5 µg/dL，尿 Pb 水平（ULL）为 1240 µg/dL。该患者被诊断为急性 Pb 中毒和急性肝功能衰竭。在另一个慢性暴露病例中，一名 56 岁男性在 Pb 和 Mn 冶炼厂工作了 15 年。他因严重恶心、呕吐和阵发性腹痛被带到急诊室，疼痛发作时疼痛难以忍受。他的 BLL 为 64.8 µg/dL，ULL 为 38 µg/dL，但血液和尿液 Mn 水平正常。该患者被诊断为慢性 Pb 中毒。两名患者均接受了依地酸钙二钠（CaNaEDTA）螯合治疗。急性重度 Pb 中毒的女性患者恢复良好，经治疗后出院，而重度 Pb 中毒幸存的男性患者被诊断为肺癌。
结论
急性和慢性重度 Pb 中毒的临床表现不同。用 CaNaEDTA 进行螯合治疗通过降低 BLL 被证明是两种情况下有效的救命治疗方法。职业性接触 Pb 和 Mn 似乎不会增加 Mn 的神经毒性；然而，不能排除在同一患者中 Mn 共同暴露可能会增加 Pb 毒性的可能性。
Zotero 插件