Lead Paint Removal >> Health Effects Caused By Lead Poisoning

Health effects caused by lead exposure can be subdivided into five developmental stages: Normal, physiological changes of uncertain significance, pathophysiological changes, overt symptoms (morbidity), and mortality. Within this process there are no sharp distinctions, butrather a continuum Health Effects Caused By Lead Poisoning of effects. 

Boundaries between categories overlap due to the wide variation of individual responses and Health Effects Caused By Lead Poisoning exposures in the working population. OSHA's development of the lead standard focused on pathophysiological changes as well as later stages of disease. 1. Heme Synthesis Inhibition. The earliest demonstrated effect of lead involves its ability to inhibit at least two enzymes of the heme synthesis pathway at very low blood levels. 

Inhibition Health Effects Caused By Lead Poisoning of delta aminolevulinic acid dehydrase (ALA-D) which catalyzes the conversion of deltaaminolevulinic acid (ALA) to protoporphyrin is observed at a blood lead level below 20 µg/dl. At a blood lead level of 40 µg/dl, more than 20% of the population would have 70% inhibition of ALA-D. 

There is an exponential increase in ALA excretion at blood lead levels greaterthan 40 µg/dl. Another enzyme, ferrochelatase, Health Effects Caused By Lead Poisoning is also inhibited atlow blood lead levels.Inhibition of ferrochelatase leads to increased free erythrocyte protoporphyrin (FEP) in the blood which can then bind to zinc to yield zinc protoporphyrin. 

At a blood lead level of 50 µg/dl or greater, Health Effects Caused By Lead Poisoning nearly 100% of the population will have an increase in FEP. There is also an exponential relationship between blood lead levels greater than 40 µg/dl and the associated ZPP level, which has led to the development of the ZPP screening test for lead exposure. 

While the significance of these effects is subject to debate, Health Effects Caused By Lead Poisoning it is OSHA's position that these enzyme disturbances are early stages of a disease process which may eventually result in the clinical symptoms of lead poisoning. Whether or not the effects do progress to the later stages of clinical disease, disruption of these enzyme processes over a working lifetime is considered to be a material impairment of health. 

One of the eventual results of lead-induced inhibition of enzymes in the heme synthesis pathway is anemia which can be asymptomatic if mild but associated with a wide array of symptoms including dizziness,fatigue, and Health Effects Caused By Lead Poisoning tachycardia when more severe. 

Studies have indicated that lead levels as low as 50 µg/dl can be associated with a definite decreased hemoglobin, although most cases of lead-induced anemia, as well as shortened red-cell survival times, occur at lead levels exceeding 80 µg/dl. Inhibited hemoglobin synthesis is more common Health Effects Caused By Lead Poisoning in chronic cases whereas shortened erythrocyte life span is more common in acute cases. 

In lead-induced anemias, Health Effects Caused By Lead Poisoning there is usually a reticulocytosis along with the presence of basophilic stippling, and ringed sideroblasts, although none of the above are pathognomonic forlead-induced anemia. 2. Neurological Effects.Inorganic lead has been found to have toxic effects on both the central and peripheral nervous systems. 

The earliest stages of lead-induced central nervous system effects first manifest themselves in the form of behavioral disturbances and central nervous system symptoms including irritability,restlessness, insomnia and Health Effects Caused By Lead Poisoning other sleep disturbances, fatigue, vertigo, headache, poor memory, tremor, depression, and apathy. 

With more severe exposure, symptoms can progress to drowsiness, stupor, hallucinations, delirium, convulsions and Health Effects Caused By Lead Poisoning coma. The most severe and acute form of lead poisoning which usually follows ingestion or inhalation of large amounts of lead is acute encephalopathy which may arise precipitously with the onset of intractable seizures, coma, cardio respiratory arrest, and death within 48 hours. 

While there is disagreement about what exposure levels are needed to produce the earliest symptoms, Health Effects Caused By Lead Poisoning most experts agree that symptoms definitely can occur at blood lead levels of 60 µg/dl whole blood and therefore recommend a 40 µg/dl maximum. The central nervous system effects frequently are not reversible following discontinued exposure or chelation therapy and when improvement does occur, it is almost always only partial. 

The peripheral neuropathy resulting from lead exposure characteristically involves only motor function with minimal sensory damage and Health Effects Caused By Lead Poisoning has a marked predilection for the extensor muscles of the most active extremity. The peripheral neuropathy can occur with varying degrees of severity. The earliest and mildest form which can be detected in workers with blood lead levels as low as 50 µg/dl is manifested by slowing of motor nerve conduction velocity often without clinical symptoms. 

With progression of the neuropathy there is development of painless extensor muscle weakness usually involving the extensor muscles of the fingers and hand in the most active upper extremity, Health Effects Caused By Lead Poisoning followed in severe cases by wrist drop or, much less commonly,foot drop. 

In addition to slowing of nerve conduction, electromyographical studies in patients with blood lead levels greater than 50 µg/dl have demonstrated a decrease in the number of acting motor unit potentials, an increase in the duration of motor unit potentials, and spontaneous pathological activity including fibrillations and Health Effects Caused By Lead Poisoning fasciculations. 

Whether these effects occur at levels of 40 µg/dl is undetermined. While the peripheral neuropathies can occasionally be reversed with therapy, Health Effects Caused By Lead Poisoning again such recovery is not assured particularly in the more severe neuropathies and often improvement is only partial. The lack of reversibility is felt to be due in part to segmental demyelination. 

3. Gastrointestinal. Lead may also affect the gastrointestinal system producing abdominal colic or diffuse abdominal pain, constipation, obstipation, diarrhea, anorexia, nausea and vomiting. Lead colic rarely develops at blood lead levels below 80 µg/dl. 4. Renal. Renal toxicity represents one of the Health Effects Caused By Lead Poisoning most serious health effects of lead poisoning.

In the early stages of disease nuclear inclusion bodies can frequently be identified in proximal renal tubular cells. Renal function remains normal and the changes in this stage are probably reversible. With more advanced disease there is progressive interstitial fibrosis and Health Effects Caused By Lead Poisoning impaired renal function. Eventually extensive interstitial fibrosis ensues with sclerotic glomeruli and dilated and atrophied proximal tubules; all represent end-stage kidney disease. 

Azotemia can be progressive, eventually resulting in frank uremia necessitating dialysis. There is occasionally associated hypertension and Health Effects Caused By Lead Poisoning hyperuricemia with or without gout. Early kidney disease is difficult to detect. The urinalysis is normal in early lead nephropathy and the blood urea nitrogen and serum creatinine increase only when two-thirds of kidney function is lost. 

Measurement of creatinine clearance can often detect earlier disease as can other methods of measurement of glomerular filtration rate. An abnormal Ca-EDTA mobilization test has been used to differentiate between lead-induced and other nephropathies, Health Effects Caused By Lead Poisoning but this procedure is not widely accepted. A form of Fanconi syndrome with aminoaciduria, glycosuria, and hyperphosphaturia indicating severe injury to the proximalrenal tubules is occasionally seen in children.

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