A father brings his two children (ages 6 and 4) and several neighbor children to the doctor due to symptoms of abdominal pain, loss of appetite, constipation, weakness and irritability. The children use well water for drinking and cooking that is near where the father runs a business selling used batteries. The doctor suspects environmental factors may be causing the children's illnesses and wants to investigate potential causes in the children, surrounding environment and other affected people. The father's battery business could be exposing the children to toxins. The doctor plans to educate the public on environmental hazards through an informational leaflet.

1. Environmental Case
Dr Momin Kashif

2. Doctor as Detective
A father brings his two children (M-6,
F-4) who have complain of
abdominal pain, loss of appetite,
constipation, weakness and
tiredness.
Their father also complained that his
children have become irritable and
disturbing.
He also reported that his neighbour's
3 or 4 children are having similar
complaints.
They use well water for drinking and
cooking purposes which is in their
home vicinity.
He has business of selling
old/discarded batteries.
you suspected some
environmental factors for
their ill health....
1. What line of investigations u
can plan for the diagnosis?
In chilren
In surrounding environment
In other people
2. How father's business is
associated with the children
disease?
3. What are your suggestions
for prevention and protection.
4. Make a Information leaflet in
regional language for public
awareness of this
environmental hazard.

3. What are the symptoms

4. Normal RBCs
Granules in
nucleated RBCs

6. Long bone Radiograph of Hands - "lead lines" shown as increased density on
the metaphysis growth plate of the proximal segments of phalanges and distal
segments of ulna and radius in a four year-old female with radiological growth
retardation and blood lead level of 37.7 µg/dL.

7. What are the symptoms
• Symptoms of lead poisoning are varied. They
may affect many parts of the body. Most of the
time, lead poisoning builds up slowly.
• It follows repeated exposures to small quantities
of lead.
• Lead toxicity is rare after a single exposure or
ingestion of lead.

8. Continuum of signs and symptoms of
ongoing lead exposure
• Lowest Exposure Dose
Signs and Symptoms:
Impaired Abilities
(patient may appear
asymptomatic)
1. Decreased learning and
memory
2. Lowered IQ
3. Decreased verbal ability
4. Impaired speech and
hearing functions
5. Early signs of hyperactivity
or ADHD
• Low Exposure Dose Signs
and Symptoms
1. Myalgia or paresthesia
2. Mild fatigue
3. Irritability
4. Lethargy
5. Occasional abdominal
discomfort

9. Continuum of signs and symptoms of
ongoing lead exposure
• Moderate Exposure Dose
Signs and Symptoms
1. Arthralgia
2. General fatigue
3. Difficulty
concentrating/Muscular
exhaustibility
4. Tremor
5. Headache
6. Diffuse abdominal pain
7. Vomiting
8. Weight loss
9. Constipation
• High Exposure Dose Signs
and Symptoms
1. Paresis or paralysis
2. Encephalopathy—may
abruptly lead to seizures,
changes in consciousness,
coma, and death
3. Lead line (blue-black) on
gingival tissue
4. Colic (intermittent, severe
abdominal cramps)

10. What causes lead poisoning?
• house paints
• toys and household items
painted
• toys made and painted
• bullets, curtain weights,
and fishing sinkers made
of lead
• pipes and sink faucets,
which can contaminate
drinking water
• paint sets and art
supplies
• jewelry, pottery, and lead
figures
• storage batteries
• kohl or kajal eyeliners
• some traditional ethnic
medicines
• soil polluted by car
exhaust or chipping
house paint

11. Who is at risk for lead poisoning?
• Children are at the highest risk of lead
poisoning, especially if they live in old houses
with chipping paint
• People in developing countries are also at a
higher risk

12. How is lead poisoning diagnosed?
• blood lead test
• CBC
• amount of iron storing cells in the blood
• X-rays,
• and possibly a bone marrow biopsy

13. How is lead poisoning treated?
• The first step of treatment is to locate and remove the source of
the lead.
• Keep children away from the source.
• If it cannot be removed, it should be sealed.
• In more severe cases, a procedure known as chelation therapy
can be used. This treatment binds to lead that has accumulated
in your body. The lead is then excreted in your urine.
• Activated charcoal can be used to bind the lead in the
gastrointestinal tract and encourage elimination via defecation.
A chemical called EDTA may also be used
• Even with treatment, it can be hard to reverse the effects of
chronic exposure.

14. What is the outlook for lead
poisoning?
• Adults with moderate exposure usually recover
without any complications.
• In children, recovery can take time. Even low
lead exposure can cause permanent intellectual
disability.

15. How can lead poisoning be
prevented?
Simple steps can help you prevent lead poisoning. These include:
1.Avoid painted toys and canned goods.
2.Keep your home free from dust.
3.Use only cold water to prepare foods and drinks.
4.Make sure everyone washes their hands before
eating.
5.Clean faucets and aerators regularly.
6.Wash children’s toys and bottles regularly.
7.Teach your children to wash their hands after playing.
8.Use lead-free paint in your home.
9.Avoid areas where lead-based paint may have been
used.

16. How can lead poisoning be
prevented?
for patients
• Eliminate source of lead exposure
• Flushing the standing water from the lines and
faucet for a few minutes before use and using cold
water for drinking may reduce exposure.
• maintain a diet high in calcium and iron
• continue to monitor blood lead levels.

17. Other Environmental Hazards
• Arsenic
• Nitrates
• Excess or less flourides
• Radioactive substances
• Cadmium
• Organic materials degradation

18. The Environmental Series continue….
What changes you wish to bring in your life and in
your environment for better health…
1.
2.
3.
………….
Thank you