User:Delldot/Pb

encephalopathy starting at 70 um/dl but usu 100.

acute encephalop. at 150. subacute or chronic more common than acute.

description of early, late signs of lead encephalopathy.Casarett, Klaassen, Doull (2007) pp. 944 [http://books.google.com/books?id=4yi7-j48uhIC&pg=PT994&dq=toxicology+%22lead+poisoning%22&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2002&as_maxm_is=0&as_maxy_is=2009&as_brr=0&client=firefox-a#v=onepage&q=toxicology%20%22lead%20poisoning%22&f=false]

s/s show up at 40 but neurological damage may occur earlier and be missed.

organic pb shows particular affinity for brain tissue.[http://books.google.com/books?id=lr0s5OSkCrkC&pg=PA397&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=%22lead%22&f=false p.47]

inorganic s/s per se.[http://books.google.com/books?id=lr0s5OSkCrkC&pg=PA397&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=%22lead%22&f=false p.47]

impaired vision.[http://books.google.com/books?id=lr0s5OSkCrkC&pg=PA397&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=%22lead%22&f=false p.47]

The delay between exposure and onset of symptoms varies widely depending partly on the individual and intensity and tempo of exposure.

Lead is also toxic at levels below those that cause recognizable symptoms.

wristdrop rare now.

peripheral neuropathy rare in children but often in adults.{{cite book |author =Osterhoudt, K.C.; Ewald, M.B.; Shannon, M.; Henretig, F.M. |title= Textbook of Pediatric Emergency Medicine, Volume 355, 5th edition |chapter= Toxicologic emergencies |editor= Fleisher, G.R.; Ludwig, S.; Henretig, F.M. |year= 2006|publisher= Lippincott Williams & Wilkins|location= |isbn= 0781750741 |page= 983|url= |accessdate= |quote= }}

encephalopathy sometimes starts abruptly p a latent period.

anemia a late sign.[http://books.google.com/books?id=iB0odpe_jCwC&pg=PA5&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=lead%20poisoning&f=false p. 392]

acute v. chronicBrunton (2007) pp. 1131

However, absorption in the lungs depends on the size of the particles inhaled.Grant (2009) pp. 771

Small objects, e.g. paint chips or sip of ceramic glaze, may contain hundreds of milligrams of lead.Kosnett (2006) pp.241 [http://books.google.com/books?id=25avFCpfQAcC&printsec=frontcover&dq=Poisoning+and+Drug+Overdose&client=firefox-a#v=onepage&q=&f=false]

pb is a widespread environmental pollutant.

{{Cite journal| pmid = 19757511| year = 2009| last1 = Watts | first1 = J.| title = Lead poisoning cases spark riots in China| volume = 374| issue = 9693| pages = 868–812| journal = Lancet| doi = 10.1016/S0140-6736(09)61612-3| s2cid = 28603179}} [http://www.sciencedirect.com.proxy.library.vcu.edu/science?_ob=ArticleURL&_udi=B6T1B-4X6FRG4-9&_user=709070&_coverDate=09%2F18%2F2009&_rdoc=12&_fmt=high&_orig=browse&_srch=doc-info(%23toc%234886%232009%23996250306%231489202%23FLA%23display%23Volume)&_cdi=4886&_sort=d&_docanchor=&_ct=35&_acct=C000039639&_version=1&_urlVersion=0&_userid=709070&md5=0d517ddf8076d4786d9143c0febf175e]

People who live in environments polluted by lead can experience elevated blood lead levels.

whereas in the general population xposure is most oft thru ingestion, inhalation is more common in occupational setting.{{Cite journal| first1 = E.| last5 = Kling | first2 = R.| last2 = Copes| last4 = Kennedy| last3 = Mattman | first3 = A. | first4 = J. | first5 = R. | first6 = A.| title = Lead and mercury exposures: interpretation and action| last1 = Brodkin| url = http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=17200393| last6 = Yassi| format = Free full text| journal = Canadian Medical Association Journal| volume = 176| issue = 1| pages = 59–63| date=Jan 2007 | issn = 0820-3946| pmid = 17200393| pmc = 1764574 | doi = 10.1503/cmaj.060790}}

pb-containing paint particles are part of dust that gets on kids' hands, toys.

pb still used in bridge, maritime paint.{{cite book |author = |title= Rudolph's Pediatrics, 21st edition|chapter= |editor= Rudolph, C.D. |year= 2003|publisher= McGraw-Hill Professional |location= |isbn= 0838582850 |page= |pages= |url= |accessdate= |quote= |ref=CITEREF }} [http://books.google.com/books?id=6UNcdICzlp8C&pg=PA368&dq=lead+poisoning+prognosis&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2003&as_maxm_is=0&as_maxy_is=&as_brr=0&client=firefox-a#v=onepage&q=lead%20poisoning%20prognosis&f=false p.368]

repeat opening , closing window common cause of paint -> dust.

dust more common than pica as pb poisoning [per se] cause.

children: Mouthing toys, consuming house dust, yard soil.Kosnett (2006) pp.237

in the US, 3/4 houses b4 '80 have pb paint inside.

24 million homes (just US?) have pb paint.

pb poisoning has been caused by water wtih pb solder.

in some develop. countries, eye shadow appl to infant boys, girls.# (2007) pp. [http://books.google.com/books?id=gnjMX_jtvYoC&pg=PA706&dq=lead+poisoning+prognosis&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2003&as_maxm_is=0&as_maxy_is=&as_brr=0&client=firefox-a#v=onepage&q=lead%20poisoning%20prognosis&f=false]

kids have greater distribution of pb in soft tissues incl brain.

[http://books.google.com/books?id=oA7qSOvYZxUC&pg=PA983&dq=chronic+lead+poisoning&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2003&as_maxm_is=0&as_maxy_is=&as_brr=0#v=onepage&q=chronic%20lead%20poisoning&f=false] p.983

In part because it can replace calcium ions in biological interactions, lead is able to pass through the protective blood-brain barrier which prevents many toxins from entering the brain.

pb interferes with bone metabolism in bone and teeth and has been associated with cavities.

pb acts on capillary endothelium in cns, causes glial proliferation, extravasation of plasma, other stuff.# (2007) pp. [http://books.google.com/books?id=gnjMX_jtvYoC&pg=PA706&dq=lead+poisoning+prognosis&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2003&as_maxm_is=0&as_maxy_is=&as_brr=0&client=firefox-a#v=onepage&q=lead%20poisoning%20prognosis&f=false p.705]

changes in cytoskeletal proteins

inhibits ach release, increase dopamine norepi.

diarrhea discourages pb absorption, constipation increases it.# (2007) pp. [http://books.google.com/books?id=gnjMX_jtvYoC&pg=PA706&dq=lead+poisoning+prognosis&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2003&as_maxm_is=0&as_maxy_is=&as_brr=0&client=firefox-a#v=onepage&q=lead%20poisoning%20prognosis&f=false]

malnutrition + increased fat diet mb increase pb absorb.

pb and ca++ compete for a single absorption channel.[http://books.google.com/books?id=gnjMX_jtvYoC&pg=PA703&dq=%22lead+toxicity%22&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2003&as_maxm_is=0&as_maxy_is=2009&as_brr=0&client=firefox-a#v=onepage&q=%22lead%20toxicity%22&f=false p.703]

0.5%/day from urine, independent of bll, 0.2%/d (each?) all other routes , ditto.Grant (2009) pp. 773

released from bone faster in pregnancy, lactation, menopause, osteoporosis, immobilization, and hyperthyroidism; b/c increased bone turnover.{{Cite journal| first1 = N. D.| title = Mechanisms of lead-induced hypertension and cardiovascular disease| url = http://ajpheart.physiology.org/cgi/pmidlookup?view=long&pmid=18567711| format = Free full text| journal = American Journal of Physiology. Heart and Circulatory Physiology| volume = 295| issue = 2| pages = H454–H465| date=Aug 2008 | issn = 0363-6135| pmid = 18567711| pmc = 2519216| last1 = Vaziri| doi = 10.1152/ajpheart.00158.2008}}

95% pb stored in bone, 4% in brain liver kidneys, 1% in blood.[http://web.ebscohost.com.proxy.library.vcu.edu/ehost/pdf?vid=5&hid=105&sid=7efe4b89-aa12-483d-9f14-7882b71b12a7%40replicon103 Pearce 07]

pb substitutes for ca++ in hydroxyapetite in bone.

pb accumulates where there are hi ca++ conc's and in tissues and organs w/highest mtmt activity.Grant (2009) pp. 771

Over 99% of lead in the blood is bound to red blood cells.

File:Heme synthesis.png

binds sulfhydryl, phosphate, carboxyl; thereby blocks enzymes, other macromlcls.Kosnett (2006) pp.238 [http://books.google.com/books?id=25avFCpfQAcC&printsec=frontcover&dq=Poisoning+and+Drug+Overdose&client=firefox-a#v=onepage&q=&f=false]

Lead impairs a variety of enzyme systems and is toxic to those dependent on calcium and zinc.

pb interferes with ALAD -> increased circulating ALA -> decrease in GABA release -> maybe why you see behavioral disorders.

extensive discussion fo pb pathophys: fucks up cristae in mtmt, alters ca++ uptake into cells, strongly binds sulfhydryl groups on proteins, fucks up structural proteins, E metabolism, cell respiration, enhances spontaneous neurotrans release, inhibits stimulated release.{{Cite journal| last1 = Needleman | first1 = H.| title = Lead poisoning| journal = Annual Review of Medicine| volume = 55| issue = | pages = 209–222| year = 2004| pmid = 14746518| doi = 10.1146/annurev.med.55.091902.103653}} [http://arjournals.annualreviews.org.proxy.library.vcu.edu/doi/full/10.1146/annurev.med.55.091902.103653]

interferes with synaptogenesis in rat pups who drink pb-contaminated milk from mothers.

Lead also causes red blood cells to become more fragile by interfering with another enzyme called pyrmidine-5'-nucleotidase.

messes with nucleotide metabolism, bunch of other stuff.Kosnett (2006) pp.238 *{{cite book |author = Kosnett, M.J. |title= Poisoning & Drug Overdose, 5th edition |chapter= Lead |editor= Olson, K.R. |year= |publisher= McGraw-Hill Professional |location= |isbn= 0071443339 |page= 2006 |url= |accessdate= |quote= |ref=CITEREFKosnett06Pois }}

thyrroid fuckage.

• {{cite book |author = Chisolm, J.J. |title= Oski's Essential Pediatrics, 2nd edition |chapter= Lead poisoning |editor= Crocetti, M.; Barone, M.A.; Oski, F.A. |year= 2004 |publisher= Lippincott Williams & Wilkins |location= |isbn= 0781737702 |page= |pages= |url= |accessdate= |quote= |ref=CITEREFChisolm04 }}

[[http://books.google.com/books?id=I3Kh1cNJxyUC&pg=PA223&dq=lead+poisoning+prognosis&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2003&as_maxm_is=0&as_maxy_is=&as_brr=0#v=onepage&q=lead%20poisoning%20prognosis&f=false p. 222]

not known why pb causes cancer, but it does interfere with PKCs, wich increases DNA synth, which increases cell division + overgrowth, whcih may underlie carcinogenicity.[http://books.google.com/books?id=iB0odpe_jCwC&pg=PA5&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=lead%20poisoning&f=false p. 392]

pb forms complexes with acids in nuclei, appears to have a protective fx.[http://books.google.com/books?id=lr0s5OSkCrkC&pg=PA397&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=%22lead%20toxicity%22&f=false p. 275]

pb damages mtmt and inhibits their fn.[http://books.google.com/books?id=lr0s5OSkCrkC&pg=PA397&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=%22lead%20toxicity%22&f=false p. 275]

Lead colic, may be caused by lead's interference with normal nerve function of the gastrointestinal tract.

pb interferes with myelin formation, messes wtih BBB integrity.

pb interacts with mptp, causes mpt.#CITEREFKosnett05 (2005) pp. 822

messes up neurotrans--fucks with extracell ca++, so inhibits cholinergic ntnt .[http://books.google.com/books?id=iB0odpe_jCwC&pg=PA5&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=lead%20poisoning&f=false p. 392]

pb also interferes with dopamine, aminobutyric acid.[http://books.google.com/books?id=iB0odpe_jCwC&pg=PA5&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=lead%20poisoning&f=false p. 392]

prevents oligodendrocyte differentiation, which may be why such harmful developmental fx.[http://books.google.com/books?id=lr0s5OSkCrkC&pg=PA397&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=%22lead%20toxicity%22&f=false p. 287]

because of incomplete bbb, fetuses and children <36 mo brains and CNS most affected by pb exposure. [http://journals.lww.com/ajnonline/Fulltext/2008/10000/Lead_Hazards_for_Pregnant_Women_and_Children__Part.23.aspx]

children absorb pb more easily than adults.

in children, changes in bone shape from pb.[http://books.google.com/books?id=iB0odpe_jCwC&pg=PA5&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=lead%20poisoning&f=false p. 392]

decreased testicular function, incl decrease in circulating testosterone.[http://books.google.com/books?id=iB0odpe_jCwC&pg=PA5&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=lead%20poisoning&f=false p. 392]

pb - > reduced growth in children.{{Cite journal | journal = Journal of Occupational Health | issn = 1341-9145 | url = http://www.jstage.jst.go.jp/article/joh/51/1/1/_pdf| format = Free full text (PDF) | doi = 10.1539/joh.K8003 | pmid = 18987427 | pages = 1–12 | year = 2009 | issue = 1 | title = Lead toxicity: does the critical level of lead resulting in adverse effects differ between adults and children? | volume = 51| author = Murata K | first = I. T.| last2 = Iwata | first2 = Toyoto | last3 = Dakeishi | first3 = Miwako | last4 = Karita | first4 = Kanae | s2cid = 27759109 }}

[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1849937&rendertype=table&id=t1-ehp0115-000463 table of s/s at different levels] - could make horizontal bar graph of s/s showing up after different levels.

There may be a connection between low lead exposure and high blood pressure (possibly due to changes in kidney function), but this is controversial.

at pb conc's very hi, kidney dysfn impairs pb excretion mb.Grant (2009) pp. 773

nephropathy at blls >60 ug/dl.Grant (2009) pp. 789

child's IQ down for maternal bll up during pregnancy, delivery.{{Cite journal| last1 = Bradberry | first1 = S.| last2 = Vale | first2 = A.| title = Dimercaptosuccinic acid (succimer; DMSA) in inorganic lead poisoning| journal = Clinical Toxicology (Philadelphia, Pa.)| volume = 47| issue = 7| pages = 617–631| year = 2009| pmid = 19663612| doi = 10.1080/15563650903174828| s2cid = 42138258}}

[http://www.informaworld.com.proxy.library.vcu.edu/smpp/section?content=a913846344&fulltext=713240928]

even 12 years later, pb in childhood correlated with school failure, reading impairment.

correlation btw umbilical cord blood and neuro performance at age 2.

decrease in iq and other cognitive abilities per pb exposure in children is even more pronounced at levels <10 ug/dl.

IQ decreases apparently permanent.Pearson, Schonfeld (2003) [http://books.google.com/books?id=6UNcdICzlp8C&pg=PA368&dq=lead+poisoning+prognosis&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2003&as_maxm_is=0&as_maxy_is=&as_brr=0&client=firefox-a#v=onepage&q=lead%20poisoning%20prognosis&f=false pp.369]

hearing loss prevents from learning speech in young child.

Failure in school and reading problems have also been linked to lead exposure.

neuropsych testing for cognitive dysfn.{{Cite journal| pmid = 19697571| year = 2009| last1 = Ragan | first1 = P.| last2 = Turner| title = Working to prevent lead poisoning in children: getting the lead out| volume = 22| issue = 7| pages = 40–45| journal = JAAPA : Official Journal of the American Academy of Physician Assistants | first2 = T. | doi=10.1097/01720610-200907000-00010| s2cid = 41456653}}[http://www.jaapa.com/Working-to-prevent-lead-poisoning-in-children-Getting-the-lead-out/article/139447/]

hair pb can show the time course of exposure but is not reliable b.c pb varies from hari to hair on one person.p. 706 not really used though because not reliable.{{Cite journal| pmid = 19697571| year = 2009| last1 = Ragan | first1 = P.| last2 = Turner| title = Working to prevent lead poisoning in children: getting the lead out| volume = 22| issue = 7| pages = 40–45| journal = JAAPA : Official Journal of the American Academy of Physician Assistants | first2 = T. | doi=10.1097/01720610-200907000-00010| s2cid = 41456653}}[http://www.jaapa.com/Working-to-prevent-lead-poisoning-in-children-Getting-the-lead-out/article/139447/]

peripheral nerve conduction time, slowed in pb exposure can detect even subclinical pb increase.706

One BLL measurement cannot distinguish between a high-level exposure over a short time and a low-level one over a chronic period.

there's a risk of contamination of tubes w/pb used to collect blood samples.

[http://content.nejm.org/cgi/content/full/353/5/498 Diagnosis from the Blood Smear]

NEJM Barbara J. Bain

bll may not be available immediately from the lab--sometimes chelation therapy is started before results are back.

Blood from capillaries, e.g. from a finger prick, can be used to measure blood lead levels, but abnormal findings are usually rechecked with blood from veins due to the possibility of contamination of the capillary sample with tiny amounts of dust on skin.

ARE YOU SURE EP AND ZPP ARE THE SAME THING? I.e. is there a zn in EP? Grant (2009) pp. 784 suggests yes.

CDC: "universal screening for children begin 6 mo."

High dietary calcium impedes absorption of lead and is indicated for those who work in an environment that puts them at risk for lead exposure.Trevor, Katzung, Masters (2007) pp. 480 Adequate calcium intake has been recommended especially for children and pregnant and lactating women.{{Cite journal| pmid = 15703449| year = 2005| last1 = Kalia | first1 = K.| last2 = Flora| title = Strategies for safe and effective therapeutic measures for chronic arsenic and lead poisoning| volume = 47| issue = 1| pages = 1–21| journal = Journal of Occupational Health| doi = 10.1539/joh.47.1 | first2 = S. J.| s2cid = 6840312}}

chelating agents used for treatment of lead poisoning are edetate disodium calcium (CaNa₂EDTA), dimercaprol (BAL), and succimer.

4 chelating agents: dimercaprol (BAL) and edta are parenteral, d-penacillamine and succimer are oral.706

Removal from lead workplace is part of mgmt of hi blls.{{Cite journal| first1 = J.| last2 = Wedeen| last3 = Rothenberg | first2 = P.| last4 = Hipkins | first3 = J.| last5 = Materna| last6 = Schwartz | first4 = L. | first5 = L.| last8 = Woolf | first6 = S. | first7 = H.| last1 = Kosnett | first8 = A.| title = Recommendations for Medical Management of Adult Lead Exposure| last7 = Hu| journal = Environmental Health Perspectives| volume = 115| issue = 3| pages = 463–471| date=Mar 2007 | issn = 0091-6765| pmid = 17431500| pmc = 1849937| doi = 10.1289/ehp.9784}}

adequate fluids are given to support kidney function, but not too much, which might exacerbate cerebral swelling. pp. 1319-20

Ca-EDTA primary rx in humans and domestic animals.{{Cite journal| last1 = Redig | first1 = P.| last2 = Arent | first2 = L.| title = Raptor toxicology| journal = The Veterinary Clinics of North America. Exotic Animal Practice| volume = 11| issue = 2| pages = 261–282, vi| date=May 2008 | issn = 1094-9194| pmid = 18406387 | doi = 10.1016/j.cvex.2007.12.004}}

vit c may reduce pb toxicity.

children 10-20 ug/dL: rm source, nutritional evaluation, continued screening. 20-44: maybe chelation, + enviro eval and remediation.

chelation recommended for children with >45 ug/dL bll.Merrill, JC; Morton, JJP; Soileau, SD (2007) p. 862

d-penacillamine side fx, less fxive.Kosnett (2006) pp.241

blls monitored before and during chelation to see if more needed, make sure it's working.Kosnett (2006) pp.241

encephalopathy in adults usu occurs > 150 μg/dL, but 90-120 μg/dL can cause.{{Cite journal| pmid = 18690981| last1 = Karri| date=Jan 2008 | first = S. S.| last2 = Saper | first2 = R.| last3 = Kales | first3 = S.| title = Lead Encephalopathy Due to Traditional Medicines| volume = 3| issue = 1| pages = 54–59| issn = 1574-8863| pmc = 2538609| journal = Current Drug Safety| doi = 10.2174/157488608783333907}} children can get it at >70-90 μg/dL.

due to aggressive use of chelation therapy, mortality is low.{{Cite journal| pmid = 19697571| year = 2009| last1 = Ragan | first1 = P.| last2 = Turner| title = Working to prevent lead poisoning in children: getting the lead out| volume = 22| issue = 7| pages = 40–45| journal = JAAPA : Official Journal of the American Academy of Physician Assistants | first2 = T. | doi=10.1097/01720610-200907000-00010| s2cid = 41456653}}[http://www.jaapa.com/Working-to-prevent-lead-poisoning-in-children-Getting-the-lead-out/article/139447/]

in children, If symptoms of poisoning occur more than once, chances that effects will be permanent increase.

hi mort rate pb encephalopathy. [http://books.google.com/books?id=Bvtkl3XUC5AC&pg=RA1-PA479&dq=toxicology+%22lead+poisoning%22&lr=&as_drrb_is=b&as_minm_is=0&as_miny_is=2002&as_maxm_is=0&as_maxy_is=2009&as_brr=0&client=firefox-a#v=onepage&q=toxicology%20%22lead%20poisoning%22&f=false ]

img of seasonal trends [http://www.biomedcentral.com/1471-2431/4/8]

children's bll's peak in summer months, mb because more exposure to soil, or b/c windows.[http://www.biomedcentral.com/1471-2431/4/8] But on the whole they're heading downward

avg pb intake per day is 5-15 ug/day, all ages.Dart, RC; Hurlbut, KM; Boyer-Hassen, LV (2004) pp. 1423

ca and fe deficiencies enhance pb absorpition esp in children.Casarett, Klaassen, Doull (2007) pp. 944

Genetic factors that may be involved in vulnerability to lead toxicity include polymorphisms for the vitamin D receptor and for proteins in red blood cells which bind lead, including amino levulinic acid dehydratase; however evidence for these predispositions is limited.

File:Aulus Cornelius Celsus.jpg recognized white lead as a poison in 30 A.D.]]

Aulus Cornelius Celsus, writing ca. A.D. 30, listed white lead on a list of poisons with antidotes, and claimed it could be remedied by mallow or walnut juice rubbed up in wine.[http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Celsus/5*.html#27.12b Celsus, de Medicina, V.27.12b]{{cite journal |last=Ali |first=Esmat A. |year=1993 |title=Damage to plants due to industrial pollution and their use as bioindicators in Egypt |journal=Environmental Pollution |volume=81 |issue=3 |pages=251–255 |pmid=15091810 |doi=10.1016/0269-7491(93)90207-5 }}{{cite journal |year=2005 |date=March 2005 |title=Evidence of the involvement of plant ligno-cellulosic structure in the sequestration of Pb: an X-ray spectroscopy-based analysis |journal=Environmental Pollution |volume=134 |issue=2 |pages=217–227 |pmid=15589649 |doi=10.1016/j.envpol.2004.08.004 |last1=Marmiroli |first1=Marta |last2=Antonioli |first2=Gianni |last3=Maestri |first3=Elena |last4=Marmiroli |first4=Nelson }}

at beginning of 2oth century a higher rate of pregnancy problems was noted in women who worked in or were married to someone who worked in the pottery industry.{{cite book |title= Goldfrank's toxicologic emergencies, 8th edition |chapter= Lead |editor= Goldfrank, LR |author = Henretig FM |year= 2006 |publisher= McGraw-Hill Professional |location= |isbn= 0071437630 |pages= 1310 |url= |accessdate= |quote=}}

long-term neurological fx of pb poisoning noted 1st in 1943, followup of 'cured' pts.

childhood pb poisoning was common in the US in the 50s and 60s, and that was when they established chelation \therapy.

Blood lead levels have fallen sharply in countries that have eliminated leaded gasoline.

Currently, mean blood lead levels for children and adults are about 2 µg/dL. <-- worldwide or jsut us?

in 1960 CDC acceptable bll was 60 μg/dL.{{Cite journal| last1 = Gilbert| first1 = G.| last2 = Weiss| first2 = B.| title = A rationale for lowering the blood lead action level from 10 to 2 μg/dL| journal = Neurotoxicology| volume = 27| issue = 5| pages = 693–701| date=Sep 2006 | issn = 0161-813X| pmid = 16889836| pmc = 2212280| doi = 10.1016/j.neuro.2006.06.008}} has fig with declining levels.

EPA's phaseout of pb in gas 1973, done in 95.

KXRF became avail in 1980s.{{Cite journal| last2 = Hu| first1 = A. | first2 = H. | first3 = G.| last4 = Schwartz| last3 = Weisskopf | first4 = S.| title = Cumulative Lead Dose and Cognitive Function in Adults: A Review of Studies That Measured Both Blood Lead and Bone Lead| last1 = Shih| journal = Environmental Health Perspectives| volume = 115| issue = 3| pages = 483–492| date=Mar 2007 | issn = 0091-6765| pmid = 17431502| pmc = 1849945| doi = 10.1289/ehp.9786}}

image: [http://books.google.com/books?id=vgHXTId8rnYC&pg=PA841&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a&source=gbs_toc_r&cad=6#v=onepage&q=&f=false graph of pre-industrial vs. modern pb levels. p. 861]

birds eat the lead shot pellets when they're eating stuff for their gizzards. [http://www.flickr.com/photos/dobak/86749329/ bird img]

pets get poisoned too, maybe worse. They're an indicator for concern in kids.

Not known how well birds of prey treated for pb poisoning reintegrate into their old lives in the wild.{{Cite journal| last1 = Redig | first1 = P.| last2 = Arent | first2 = L.| title = Raptor toxicology| journal = The Veterinary Clinics of North America. Exotic Animal Practice| volume = 11| issue = 2| pages = 261–282, vi| date=May 2008 | issn = 1094-9194| pmid = 18406387 | doi = 10.1016/j.cvex.2007.12.004}}

eating birds hunted with lead shot or eating the livers of birds with chronically elevated pb has been known to increase lead levels in hunters and their families.[http://web.ebscohost.com.proxy.library.vcu.edu/ehost/pdf?vid=5&hid=105&sid=f666d6c4-abbf-482a-bac3-6757c761674c%40sessionmgr111 Pokras ecohealth]

As with humans, chelation therapy is used to treat lead poisoning animals.

Vitamin C is not an FDA approved chelating agent and, as such, is not approved as a treatment for cases of lead poisoning in humans. However, an animal study of the efficacy of various chelating agents in treatment of acute lead poisoning showed that vitamin C (ascorbic acid), along with DMSA, CDTA and DMPS increased survival, while EGTA, N-acetyl-L-cysteine (NAC) and various other agents did not.{{cite journal | pmid=2322019 | year=1990 | last1=Llobet | first1=J. M. | last2=Domingo | first2=J. L. | last3=Paternain | first3=J. L. | last4=Corbella | first4=J. | title=Treatment of acute lead intoxication. A quantitative comparison of a number of chelating agents | journal=Archives of Environmental Contamination and Toxicology | volume=19 | issue=2 | pages=185–189 | doi=10.1007/BF01056085 | s2cid=41820004 }} Furthermore, in humans, high serum levels of vitamin C have been associated with a decreased prevalence of elevated blood lead levels{{cite journal |author=Simon JA, Hudes ES |title=Relationship of ascorbic acid to blood lead levels |journal=JAMA |year=1999 |pages=2289–93 |volume=281 |issue=24 |pmid=10386552 |doi=10.1001/jama.281.24.2289|s2cid=43839184 }} and intervention with supplemental vitamin C was shown to markedly decrease lead levels in smokers (mean: 81%). Authors hypothesize, however, that this effect might be due to an inhibition of lead absorption.{{cite journal |author=Dawson E, Evans D, Harris W, Teter M, McGanity W |title=The effect of ascorbic acid supplementation on the blood lead levels of smokers |journal=J Am Coll Nutr |volume=18 |issue=2 |pages=166–70 |year=1999 |doi=10.1080/07315724.1999.10718845 |pmid=10204833}}

enceph accompanied by neurodegeneration, necrosis of cortex, cerebral swelling.[http://books.google.com/books?id=iB0odpe_jCwC&pg=PA5&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=lead%20poisoning&f=false p. 392]

Enceph may result in ment retardation, cerebral palsy, sz. [http://books.google.com/books?id=iB0odpe_jCwC&pg=PA5&dq=%22Principles+and+Methods+of+Toxicology%22&client=firefox-a#v=onepage&q=lead%20poisoning&f=false p. 392]

medical emergency and requires intensive supportive care.

Lead encephalopathy more common in children.Brunton (2007) pp. 1131

{{Cite journal| pmid = 19697571| year = 2009| last1 = Ragan | first1 = P.| last2 = Turner| title = Working to prevent lead poisoning in children: getting the lead out| volume = 22| issue = 7| pages = 40–45| journal = JAAPA : Official Journal of the American Academy of Physician Assistants | first2 = T. | doi=10.1097/01720610-200907000-00010| s2cid = 41456653}}[http://www.jaapa.com/Working-to-prevent-lead-poisoning-in-children-Getting-the-lead-out/article/139447/]

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