<prompt> A young male presented with abdominal pain for the past 2 years. He also complains of weakness in his hands. His hemoblobin level was 8 gmdL. The most likely diagnosis:Lead poisoningDuodenal ulcerCarcinoma stomachAdenomatous polyposis coli  <response>: Ans. a. Lead poisoning Ref: Parikh 6e p9.22; Reddy 33e p544, 31ste p506-508The most likely diagnosis in a young male who presented with abdominal pain for the past 2 years with complains of weakness in his hands and hemoblobin level of 8 gmdL is lead poisoning.Lead poisoningMetallic lead and all its salts are poisonous.Principal toxic salts of Lead Lead acetateQ Saturn salt or sugar of lead Lead carbonateQ safeda Lead chromateQ Lead tetra oxide red lead, vermillion, sindur Lead mono oxide litharge Lead sulphide Least toxicAt cellular level lead interacts with sulfhydryl groups and interferes in action of enzymes essential for heme synthesis, thus for hemoglobin and cytochrome production. It causes hemolysisQ.Fatal dose:Lead acetate: 20 gm; Lead carbonate: 40 gmFatal period: 1-2 daysSigns and symptoms of Lead PoisoningAcute PoisoningChronic Lead Poisoning Plumbism, saturnism Astringent or metallic taste Dry throat and thirst Abdominal painQ, nausea and vomiting, sometimes diarrhea. Peripheral circulatory collapseQ Headache, weakness, insomnia, paresthesia, depression, coma and death. Cerebellar ataxia is common in children in acute lead poisoningQ Facial pallor Earliest and most consistent signQ Weakness Punctate basophilic or basophilic stipplingQ Lead line Burtonian lines in gumsQ Colic Dry belly acheQ and constipation is late symptomQ Sterility in males and females. Wrist drop and foot dropQ Vasoconstriction leads to hypertension and arteriolar degenerationQ Lead encephalopathyQDiagnosis:Porphyrinuria mainly due to coproporphyrin III inhibitionStood testsUrine tests 200 punctate basophilia stippling cells mm3 is diagnosticQ Zinc protoporphyrin and free erythrocyte protoporphyrin 50mg100mlQ Increased lead and aminolaevulinic acid 25mg100mlQ Increased coproporphyrin CPU levels. In nonexposed person it is 150mg literQ Aminolaevulinic acid 5mg Presence of 0.25mg leadliter is diagnosticQX-ray: Radiopaque matter in GI tract ingested 48 hours: Radio-opaque bands lines at metaphysis of long bones in childrenQTreatment:Gastric lavage with 1 solution of sodium or magnesium sulphateQChelating agent: BAL, DMSAMost effective antidote: Calcium Disodium VersenateQIntravenous calcium chloride causes deposition of lead in skeleton from bloodQ.Peritoneal or hemodialysis.Symptomatic treatmentChronic Lead Poisoning presents with New-A B C D E FNew Neuropathy leading to weakness, wrist drop and NephropathyQ Late featureA Anemia with punctate basophilia i.e. basophilic stipplingQ Early featureB Burtonian or blue stippled lead line on gumsQC Colic abdominal pain and ConstipationQD Dry belly ache i.e. diarrhea is very rareQ Dyspepsia. Drop of wrist etc due to neuropathyQE EncephalopathyQ, EosinophiliaF Facial pallorQ earliest sign 