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Questions and Answers
What is one of the primary routes of exposure for lead?
What is one of the primary routes of exposure for lead?
What is the fatal dose of mercuric chloride?
What is the fatal dose of mercuric chloride?
Which substance inhibits heme synthesis in the body?
Which substance inhibits heme synthesis in the body?
Which is a key acute symptom associated with arsenic exposure?
Which is a key acute symptom associated with arsenic exposure?
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What is a common chronic symptom of lead exposure?
What is a common chronic symptom of lead exposure?
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Which compound is primarily associated with mercury exposure?
Which compound is primarily associated with mercury exposure?
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What neurotoxic effect is associated with chronic mercury exposure?
What neurotoxic effect is associated with chronic mercury exposure?
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What is a key gastrointestinal symptom from acute lead exposure?
What is a key gastrointestinal symptom from acute lead exposure?
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Which of the following is a method of decontamination for acute poisoning?
Which of the following is a method of decontamination for acute poisoning?
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Which condition is associated with chronic lead exposure?
Which condition is associated with chronic lead exposure?
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What is a common sign of mercury poisoning?
What is a common sign of mercury poisoning?
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Which chelation agent is used for arsenic and lead poisoning?
Which chelation agent is used for arsenic and lead poisoning?
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What symptom is associated with acute arsenic poisoning?
What symptom is associated with acute arsenic poisoning?
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What is one of the risks associated with arsenic exposure during pregnancy?
What is one of the risks associated with arsenic exposure during pregnancy?
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Which of the following conditions is a chronic effect of lead poisoning?
Which of the following conditions is a chronic effect of lead poisoning?
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Which of the following symptoms could indicate chronic mercury exposure?
Which of the following symptoms could indicate chronic mercury exposure?
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What is a characteristic feature of mercury poisoning?
What is a characteristic feature of mercury poisoning?
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What is one potential consequence of occupational lead exposure?
What is one potential consequence of occupational lead exposure?
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Which symptom indicates acute mercury poisoning?
Which symptom indicates acute mercury poisoning?
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Which laboratory test can indicate recent arsenic exposure?
Which laboratory test can indicate recent arsenic exposure?
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Which of the following is a chronic symptom of arsenic exposure?
Which of the following is a chronic symptom of arsenic exposure?
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In cases of lead poisoning, what neurological symptom is commonly presented?
In cases of lead poisoning, what neurological symptom is commonly presented?
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What is the primary mechanism of action of arsenic in the body?
What is the primary mechanism of action of arsenic in the body?
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What is a potential source of mercury exposure in humans?
What is a potential source of mercury exposure in humans?
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What is the likely diagnosis for the 35-year-old painter with fatigue, abdominal pain, constipation, and a blue-black line on his gums?
What is the likely diagnosis for the 35-year-old painter with fatigue, abdominal pain, constipation, and a blue-black line on his gums?
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What is the underlying mechanism of toxicity in cases of lead poisoning?
What is the underlying mechanism of toxicity in cases of lead poisoning?
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How can chelation therapy be effective in managing acute lead poisoning?
How can chelation therapy be effective in managing acute lead poisoning?
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Which test result in lead poisoning would indicate the presence of chronic exposure?
Which test result in lead poisoning would indicate the presence of chronic exposure?
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What medicolegal implications arise when lead poisoning is linked to occupational exposure?
What medicolegal implications arise when lead poisoning is linked to occupational exposure?
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What is a potential complication from chronic lead exposure?
What is a potential complication from chronic lead exposure?
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Which symptom is NOT typically associated with acute lead poisoning?
Which symptom is NOT typically associated with acute lead poisoning?
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What is the significance of hydrogen sulfide in lead poisoning?
What is the significance of hydrogen sulfide in lead poisoning?
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What is a characteristic clinical feature of chronic arsenic poisoning?
What is a characteristic clinical feature of chronic arsenic poisoning?
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How does arsenic exert its toxic effects in the body?
How does arsenic exert its toxic effects in the body?
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Which of the following is a common source of arsenic exposure?
Which of the following is a common source of arsenic exposure?
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The Burtonian line is associated with which type of poisoning?
The Burtonian line is associated with which type of poisoning?
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What is commonly observed in the peripheral blood smear of lead poisoning?
What is commonly observed in the peripheral blood smear of lead poisoning?
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What chelating agent is primarily used in the management of lead poisoning?
What chelating agent is primarily used in the management of lead poisoning?
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Which symptom is associated with chronic mercury poisoning?
Which symptom is associated with chronic mercury poisoning?
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Which form of mercury is primarily responsible for Minamata disease?
Which form of mercury is primarily responsible for Minamata disease?
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Study Notes
Heavy Metal Poisoning
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Arsenic
- Sources: Arsenous oxide, Paris green, herbicides
- Routes of Exposure: Oral, inhalational, cutaneous
- Fatal Dose: 200-300 mg (arsenic trioxide)
- Mechanism of Action: Binds to sulfhydryl groups, disrupts oxidative phosphorylation
- Key Acute Symptoms: Severe abdominal pain, vomiting, diarrhea (bloody/rice-water), garlic breath odor, convulsions, coma
- Key Chronic Symptoms: Skin hyperpigmentation, hyperkeratosis, peripheral neuropathy, encephalopathy, pancytopenia, Mees' lines on nails
- Diagnosis: Urine arsenic >100 mcg in 24 hours, hair/nail analysis for arsenic deposition
- Acute Management: Gastric lavage, whole bowel irrigation, chelation therapy (BAL, DMSA, penicillamine), supportive care (IV fluids, monitoring renal/liver function)
- Chronic Management: Chelation therapy (BAL, Vitamin B1), supportive therapy for neuro and renal symptoms
- Medico-legal Importance: Homicidal poisoning, occupational hazard, delays decomposition, abortion risk
- Unique Features: Arsenic delays decomposition, fetal toxicity (crosses placenta, causing intrauterine death or newborn respiratory distress)
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Lead
- Sources: Lead acetate (sugar of lead), tetraethyl lead, contaminated food, dust
- Routes of Exposure: Inhalational, oral, cutaneous
- Fatal Dose: 20 g (lead acetate), 100 mg/kg (tetraethyl lead)
- Mechanism of Action: Inhibits heme synthesis, binds to -SH groups
- Key Acute Symptoms: Colic, constipation, wrist drop, foot drop, convulsions, coma, Burtonian lines (blue-black gum line), anemia
- Key Chronic Symptoms: Neurologic: Encephalopathy, cognitive decline, peripheral neuropathy, Danbury tremor, ataxia. Hematologic: Anemia, basophilic stippling, Burtonian lines. Other: Gout, sterility
- Diagnosis: Blood lead levels >20 µg/dL, urinary lead >150 µg/L, peripheral smear: basophilic stippling of RBCs, microcytic hypochromic anemia
- Acute Management: Gastric lavage, chelation therapy (CaNa2EDTA, DMSA, succimer), supportive care (fluids, electrolytes)
- Chronic Management: Chelation therapy (CaNa2EDTA, DMSA, folic acid, thiamine), supportive therapy for neuro and renal symptoms
- Medico-legal Importance: Occupational disease, cattle poisoning, contaminant in drug abuse
- Unique Features: Post-mortem imbibition: lead line (Burtonian line) on gums, plumbism (painter's colic). Occupational exposure common in construction, battery, and paint industries
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Mercury
- Sources: Elemental mercury, mercuric chloride, methyl mercury
- Routes of Exposure: Inhalation (vapor), ingestion, skin absorption
- Fatal Dose: 1-4 g (mercuric chloride)
- Mechanism of Action: Binds to mitochondrial enzymes (pyruvate dehydrogenase)
- Key Acute Symptoms: Respiratory: Cough, dyspnea, pneumonitis. GIT: Abdominal pain, vomiting, diarrhea, metallic taste. Neuro: Tremor, ataxia, seizures. Other: Renal failure
- Key Chronic Symptoms: Neuro: Erethism (emotional instability), shyness, Danbury tremor, ataxia. GIT: Colic, constipation. Skin: Acrodynia (pink disease in children), gingivitis, sialorrhea
- Diagnosis: Urine/blood mercury levels, hair samples indicate chronic exposure to organic mercury
- Acute Management: Gastric lavage, activated charcoal, chelation therapy (BAL, DMSA), supportive care (fluid resuscitation, monitoring renal/liver function)
- Chronic Management: Chelation therapy (BAL, DMSA), supportive therapy for neuro and renal symptoms
- Medico-legal Importance: Criminal abortion, Minamata disease (methyl mercury), Mad Hatter syndrome
- Unique Features: Post-mortem imbibition: Mad Hatter syndrome (emotional instability, tremor), acrodynia (pink disease) in children due to chronic exposure. Minamata disease: environmental contamination
Burtonian Line
- A dark blue-black line that appears on the gum margins, commonly seen in chronic lead poisoning
- Lead ions accumulate in the gum tissues and react with hydrogen sulfide produced by bacteria
- Lead sulfide (PbS) is formed, leading to the characteristic dark line
Employees' Compensation Act, 1923
- Scope: Governs employer liability for work-related injuries and illnesses
-
Employer's Obligation: Employers must provide compensation to workers for injuries suffered during employment, regardless of fault
- Compensation for:
- Death or permanent disability due to workplace accidents
- Partial or temporary disability impacting the worker’s ability to earn
- Occupational diseases (lead poisoning, mercury exposure, arsenic poisoning)
- Compensation for:
- Compensation Calculation: Based on extent of injury, nature of employment, and wages of the employee
Clinical Features of Heavy Metal Poisoning
-
Arsenic:
- Acute: Severe abdominal pain, vomiting, bloody or rice-water diarrhea, metallic taste, garlic odor in breath, convulsions, coma, hyperpyrexia, hypotension, tachycardia
- Chronic: Skin hyperpigmentation, hyperkeratosis, Mees' lines on nails, peripheral neuropathy, encephalopathy, polyneuritis, pancytopenia, basophilic stippling, melanosis, Bowen's disease, skin cancer
-
Lead:
- Acute: Colic, constipation, encephalopathy, convulsions, coma, lead palsy (wrist/foot drop), Burtonian line on gums, facial pallor
- Chronic: Cognitive decline, peripheral neuropathy, wrist/foot drop, microcytic hypochromic anemia, basophilic stippling, reticulocytosis, lead line (Burtonian line), saturine gout, sterility, retinal stippling
-
Mercury:
- Acute: Cough, dyspnea, fever with chills, headache, metallic taste, Kawasaki disease-like symptoms (red palms, fever, lymphadenopathy), abdominal pain, vomiting, diarrhea, shock, pulmonary edema, tremors, convulsions, ataxia
- Chronic: Danbury tremor, erethism (emotional instability, shyness, depression), ataxia, reeling gait, acrodynia (pink disease in children), gingivitis, sialorrhea, mercuria lentis (brown discoloration of lens capsule), renal damage, Minamata disease
Important Considerations for Employer Liability in Occupational Heavy Metal Poisoning
- The Employees' Compensation Act, 1923, mandates employer responsibility for occupational diseases caused by exposure to heavy metals like lead, mercury, and arsenic.
- Failing to provide adequate safety measures, leading to employee exposure, can result in liability for the employer.
- It is crucial for employers to implement preventive measures, monitor workplace conditions, and ensure appropriate employee training and protective equipment to minimize the risk of heavy metal poisoning in the workplace.
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Description
This quiz focuses on arsenic as a heavy metal poison, covering its sources, routes of exposure, fatal doses, and symptoms. Additionally, it highlights acute and chronic management strategies, diagnosis, and medico-legal implications. Test your knowledge about the effects and treatment of arsenic poisoning.
