(B) Lead[?]LEAD is a heavy steel-grey metal & all it's salts are poisonous. Lead poisoning may be acute or chronic.oOne manifestation of chronic lead toxicity is the rheumatologic entity known as saturnine gout.oIllicitly distilled beverages may inadvertently contain harmful toxins, like metallic lead.oLead has been known to play a role in purine metabolism & renal insufficiency.CARDINAL SYMPTOMS OF LEAD INTOXICATIONAcuteChronic*. GI effects-. colic, severe pain-. severe constipation*. Peripheral, central neuropathy*. Cardiac toxicity*. Acute encephalopathy*. Chronic nephropathy*. Acute nephropathy*. Saturnine gout*. In Children*. Reproductive effects*. Growth retardation*. Hypertension?*. Behavioural problems* Anemia[?]Chronic Lead Poisoning or Plumbism or Saturnism:oChronic lead poisoning results from a daily intake of one to two mg. of lead; Lead vapour is more dangerous than dust & it is a typical cumulative poison.[?]Signs and Symptoms of Chronic Lead Poisoning:oFacial Pallor: mouth is one of the earliest and most consistent sign due to vasospasm.oAnaemia: There may be polycythaemia with polychromatophilia in early stages, but later there is anaemia which is associated with polychromasia, punctate basophilia, reticulocytosis, poikilocytosis, anisocytosis, nucleated red cells (sideroblasts) and an increase in mononuclear cells, whereas polymorphonuclear cells and platelets are decreased.-Anaemia is probably due to decreased survival time of red blood cells and inhibition of haeme synthesis by interference with the incorporation of iron into protoporphyrin.-Punctate basophilia or basophilic stippling means the presence of many dark blue-coloured pinhead sized spots in the cytoplasm of red blood cells, due to toxic action of lead on porphyrin metabolism.-Reticulocytes and basophilic stippled cells result from the inhibition of 5 pyrimidine nucleotidase, an impaired ability to rid the cell of RNA degradation products and the aggregation of ribosome.-Eosinophilia is more common than basophilic stippling. Porphyrins excreted in urine may be 500 micrograms per day.oLead Line: A stippled blue line, called Burtonian line, is seen on the gums in 50 to 70% of cases. It appears due to subepithelial deposit of granules at the junction with teeth, only near dirty or carious teeth, within a week of exposure, especially on upper jaw. It is due to formation of lead sulphide by the action of hydrogen sulphide formed by decomposed food in the mouth.-A similar blue line may be seen in cases of poisoning by mercury, copper, bismuth, iron and silver.oColic and Constipation: It is usually later symptom. Colic of intestines, ureters, uterus and blood vessels occur in 85% of cases. The colic occurs at night and the pain may be very severe.-Individual attacks last only a few minutes, but may recur for several days or weeks. Constipation is usual but diarrhoea or vomiting may occur.oLead Palsy: It usually occurs late, and is seen in less than 10% of cases.-There may be tremors, numbness, hyperaesthesia, and cramps before the actual muscle weakness. It is commoner in adults than in children, and men are particularly affected.-Muscle groups affected are those most prone to fatigue. Usually the extensor muscles of the wrist (wrist drop; radial nerve is affected), are affected, but the deltoid, biceps, anterior tibial (foot drop), and rarely muscles of eye or intrinsic muscles of hand or foot are affected.-Paralysis is associated with degeneration of the nerve and atrophy of the muscles.-Recovery may be complete but is usually slow.oEncephalopathy: Lead encephalopathy, in some form is said to be present in almost every case of plumbism. It is common in children often associated with tetraethyl lead.-Symptoms are vomiting, headache, insomnia, visual disturbances, irritability, restlessness, delirium, hallucinations, convulsions, coma and death. Lead encephalopathy is usually irreversible and about 85% have permanent brain damage.-Death occurs in about 25% cases.oCardiovascular System and Kidneys: Lead causes vascular constriction, leading to hypertension and permanent arteriolar degeneration. Chronic arteriosclerotic nephritis and interstitial nephritis occur.oReproductive System: Menstrual derangements, such as amenorrhoea, dysmenonhoea, I menorrhagia, sterility of both sexes, and abortion are, frequent. Abortion occurs in pregnant women between 3 to 6 months.oOther Systems: They are dyspepsia, anorexia, emaciation, general weakness, exhaustion, irritability, foul breath, headache, vertigo, loss of hair and drowsiness. Peripheral neuritis is rare. Retinal stippling is noticed by ophthalmoscopic examination showing presence of greyish glistening lead particles in the early phase of poisoning.