25 - Signs and Symptoms of chronic LEAD poisoning

1. Facial pallor : This is the earliest symptom.
2. Colic and Constipation : This is the first symptom that armbouses suspicion of plumbism
3. Anemia : This is associated with punctate basophilia
4. Lead line (BURTONIAN LINE) : A bluish-black line due to epithelial deposition of lead sulphide granules on the gums at the junction with the teeth. (not on teeth). Similar line may also be seen with Mercury, Copper, Bismuth, Iron and Silver poisoning.
5. Paralysis : Usually a late manifestation. Commonly causes wrist drop (extensor muscles of wrist) but may cause foot drop (peroneal muscles).
6. Lead encephalopathy : Frequently seen in children (not so common in adults).
7. Reproductive system : Menstrual disorders, abortion/still births, degenerate offsprings and sterility.

19 - organophosphorous poisoning mcqs

1q: a 5 year old child presents with confusion, increased salivation, lacrimation, fasciculations, miosis, tachycardia and hypertension. Which of the following poisons can cause these manifestations ?

a. opium
b. organophosphorous insecticide
c. dhatura
d. organochlorine pesticide

answer b. organophosphorous insecticide

explanation : only opium and organophosphorous insecticides out of the above 4 options cause miosis . it is to be noted that dhatura ( atropine ) and organochlorine cause mydriasis .

organsophosphate poisoning : organophosphate poisons irreversibly inhibit acetylcholinesterase and cause accumulation of acetylcholine at muscarinic and nicotinic receptors .

Muscarinic effects of organosphosphorous poisons are :

1. miosis and blurred vision
2. increased sweating, salivation, lacrimation
3. increased bronchial secretions, bronchoconstriction
4. abdominal cramps, diarrhea, nausea, vomiting
5. urinary frequency and incontinence

Nicotinic effects of organophosphorous poisons are :

1. on striated muscles – twitching, fasciculations, cramps and muscle paralysis
2. on sympathetic ganglia – hypertension and tachycardia

CNS effects of organophosphorous poisons are :

1. anxiety , restlessness and confusion
2. seizures and coma

- this child presents with tachycardia and hypertension which are nicotinic manifestations. Sometimes the presentation can vary due to the muscarinic effect on cardiovascular system which causes bradycardia and hypotension , but this occurs due to severe organosphosphorous poisoning .

This question was asked in the november 2002 AIIMS question paper .