Decrease Q f increase

figure 65-2 Manifestations of lead toxicity associated with varying concentrations of lead in blood of children and adults. 8-ALA = 8-aminolevulinate.

irritability, restlessness, and anxiety are next evident, usually accompanied by hypothermia, bradycardia, and hypotension. With continued exposure, or in the case of intense short-term exposure, CNS manifestations progress to delusions, ataxia, exaggerated muscular movements, and finally, a maniacal state.

The diagnosis of poisoning by tetraethyl lead is established by relating these signs and symptoms to a history of exposure. The urinary excretion of lead may increase markedly, but the concentration of lead in blood remains nearly normal. Anemia and basophilic stippling of erythrocytes are uncommon in organic lead poisoning. There is little effect on the metabolism of porphyrins, and erythrocyte protoporphyrin concentrations are inconsistently elevated. In the case of severe exposure, death may occur within a few hours or may be delayed for several weeks. If the patient survives the acute phase of organic lead poisoning, recovery usually is complete; however, instances of residual CNS damage have been reported.

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