Lead toxicity

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Sections available in full article Introduction, Presenting signs, Age predisposition, Sex predisposition, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Epidemiology (population dynamics), Diagnosis, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Subsequent management, Prevention, Control, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Rhea Morgan DVM DACVIM DACVO
Synonyms Plumbism

Introduction

  • Relatively rare poisoning.
  • Cause : ingestion of lead (must be ingested   →   poisoning needs HCl in stomach to make lead soluble).
  • Signs : gastrointestinal and neurological signs, weight loss.
  • Diagnosis : clinical signs, measurement of lead level in blood.
  • Treatment : calcium-EDTA, succimer.
  • Prognosis : good with early administration of chelating agents.

Diagnosis

Clinical signs

  • Anorexia.
  • Vomiting  Vomiting  .
  • Seizures  Seizures  .
  • Hysteria.
  • Lethargy.
  • Hyperesthesia.
  • Diarrhea.
  • Weight loss  Weight loss  .
  • Anemia  Anemia: overview  .
  • Paresis, paralysis.
  • Polyuria, polydipsia.
  • Blindness  Blindness  .
  • Abnormal gait, weakness.
  • Abdominal pain.
  • Nystagmus.
  • Regurgitation from megaesophagus.

Diagnosis

Differential diagnosis

  • Other causes of neurological signs:
    • Epilepsy.
    • Feline infectious peritonitis virus  Feline infectious peritonitis  .
    • Toxoplasmosis  Toxoplasmosis  .
    • Cryptococcosis  Cryptococcosis  .
    • Rabies  Rabies  .
  • Other toxicities:
    • Strychnine  Strychnine toxicity  .
    • Zinc
    • Chlorinated hydrocarbon
  • Inflammatory bowel disease.
  • Hepatic lipidosis

Sequelae

Prognosis

  • Generally good. Approximately 85-90% respond favorably to therapy.
  • Poor if neurological signs severe.

Expected response to treatment

  • Clinical improvement should be seen 24-48 hours.
  • After one course of therapy if blood lead levels are not < 35 ug/dl, repeat therapy. If blood lead levels after therapy are < 35 ug/dl, then monitor lead levels again in 2-3 weeks to make sure they continue to fall (or are not rising again).

Reasons for treatment failure

  • Delayed treatment.
  • Inadequate dosage or duration of therapy.
  • Failure to recognize that more than one course of therapy may be needed.
  • Premature termination of therapy due to expense.

Sources

Publications

Refereed papers

  • Knight TE & Kumar MS (2003)Lead toxicosis in cats-a review.J Feline Med Surg.5(5), 249-255.PubMed
  • Morgan R Vet al(1991)Clinical and laboratory findings in small companion animals with lead poisoning - 347 cases (1977-1986).J Am Vet Med Assoc199, 93-97.
  • Morgan R Vet al(1991)Demographic data and treatment of small companion animals with lead poisoning - 347 cases (1977-1986).J Am Vet Med Assoc199, 98-102.
  • Morgan R V (1994)Lead poisoning in small companion animals: an update (1987-1992).Vet Human Toxicol36:18-22.
  • Knight T E, Kent M & Junk E J (2001)Succimer for treatment of lead toxicosis in two cats.J Am Vet Med Assoc218: 1946-1948,1936.

Other sources of information

  • Carson T L, Osweiler G D (2002)Household and metal toxicants. In Morgan RV, Bright RN, Swartout MS (eds):Handbook of Small Animal Practice.4th Ed. WB Saunders, Philadelphia, pp. 1222-1229.

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