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Lead Toxicity  ACAM April 21, 2010  Dorothy Merritt, MD This lecture is dedicated to Clair Patterson, whose inadvertant discovery of severe lead contamination in the US while trying to date the age of the Earth, lead to the Clean Air Act of 1970 and the removal of lead from gasoline for sale in the US in 1986 despite attempts of the ETHYL Corporation to get him fired from his position at Cal Tech. His persistance paid off for the betterment of society . This lecture also recognizes Thomas Midgley, an engineer whose dabbling in chemistry resulted in lead being introduced into gasoline, CFCS (chlorofluorocarbons)  being unleashed on the atmosphere. His untimely death was from being strangled in a bed of pulleys he had himself invented for turning  polio victims, which he himself contracted after his construction of his device.  He may deserve the 20 th  century’s top “Darwin Award” for removing his DNA from the pool in a most unusual way caused  by his own invention.
Lead –Who Is Affected The Most Blood-brain barrier is not complete until 6 months of age so lead can be absorbed by CNS of fetus and  young child   ( lead crosses placenta). Absorption of lead is estimated to be as much as  FIVE TO TEN TIMES GREATER  in infants and young children than in adults. Needleman H. Ann Rev Med 2004;55:209-222
Lead: Where does it come from? ,[object Object],[object Object],[object Object],[object Object]
Lead: Where does it come from? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lead in Wine ,[object Object]
Lead in Wine ,[object Object],[object Object],[object Object]
Lead glaze used on plate imported from Portugal and sold at American Home Furnishings
Fatal Case of Lead Poisoning from Injestion of Jewelry ,[object Object],[object Object],[object Object],[object Object]
Is There A Safe Level Of Lead? ,[object Object],[object Object],[object Object],[object Object]
Occupations at risk for lead toxicity ,[object Object],[object Object],[object Object],[object Object],[object Object]
Distribution of workers with BLLs greater than or equal to 25  µg/dL,    by industry, 2003-2004 Total = 12,712 Section   44 of The Construction Chart Book, Fourth Edition, December 2007 -
Number of workers with BLLs greater than or equal to 25 or 40  µg/dL ,  by detailed construction sector, 2003-2004 1,051 406 412 92 70 41 41 39 14 Section 44 of The Construction Chart Book, Fourth Edition, December 2007
Lead Toxicology ,[object Object],[object Object],[object Object]
Lead Toxicology-BLL vs Bone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Deposition in Soft Tissue ,[object Object]
Routes of Excretion ,[object Object],[object Object],[object Object]
NOEL  N o  O bservable  E ffect  L evel  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lead and Children ,[object Object],[object Object],[object Object],[object Object]
 
Galveston, Texas-Pre IKE ,[object Object],[object Object],[object Object]
Evidence of PediatricToxicity  Below 10  µg/dL ,[object Object],[object Object],[object Object],[object Object]
Lead Toxicity Adult Conditions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recognition of Heavy Metal Exposure ,[object Object],[object Object],[object Object],[object Object]
CDC NHANES Blood Lead
Circulation  2006;114;1347-1349 Tim S. Nawrot and Jan A. Staessen NHANES DATA ,[object Object],Editorial in  Circulation 2006  with Latest NHANES Study On Lead And Vascular Disease
Lead Toxicity-Early Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lead Toxicity Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lead-Related Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lead-Related Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]
Normative Aging NIH Study Lead in Bones ,[object Object],[object Object],[object Object],[object Object]
Bone Storage ,[object Object],[object Object],[object Object]
Populations at risk for lead toxicity from increased bone turnover ,[object Object],[object Object],[object Object],[object Object],[object Object]
Populations at Risk For Lead Toxicity ,[object Object]
Populations at Risk For Lead Toxicity ,[object Object],[object Object],[object Object]
Adult Lead Exposure: Time for Change ,[object Object],[object Object],[object Object],Environ Health Perspect  115:451–454 (2007) and  115: 463-471  Brian S. Schwartz and Howard Hu
Lead Exposure and Cardiovascular Disease  A Systematic Review Ana Navas-Acien, Eliseo Guallar, Ellen K. Silbergeld and Stephen J. Rothenberg doi:10.1289/ehp.9785 (available at http://dx.doi.org/) Online 22 December 2006
Lead and Cardiovascular Disease- “Silent Killer In US” ,[object Object],[object Object],[object Object],[object Object]
Cardiovascular Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lead and Cardiovascular  ,[object Object],[object Object],[object Object],[object Object]
Lead and Hypertension ,[object Object],[object Object],[object Object],[object Object]
Heart rate variability as defined as autonomic dysfunction is more pronounced on high air pollution days in patients with increased bone lead  Epidemiology  2008; 19; 111-120 More Lead Effects
Blood Lead Predicts Homocysteine Levels ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methylation Pathways and Lead Heartfixer.com
Methylation Pathways ,[object Object],[object Object],[object Object],[object Object],[object Object]
Methylation cycle
The Association between Blood Lead Levels and Osteoporosis –Results from the Third National Health and Nutrition Examination Survey  (NHANES III)   They found a significant inverse association between lead exposure and BMD loss Is Lead Exposure a Risk Factor for Bone Loss? (CDC) YES Journal of Women’s Health Vol 14:Number 6 2005. VIJAYALAKSHMI POTULA, Ph.D., and WENDY KAYE, Ph.D. ,[object Object],[object Object],[object Object]
Past Adult Lead Exposure Is Linked To Neurodegeneration Measured By Brain MRI ,[object Object],Lead Exposure Predicts Survival in ALS Higher lead levels predict better survival !  EHP: 116;943-947
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Neurological Studies in Patients With  Elevated Bone Lead
 
Progression to renal failure
Lead Chelation in Renal Insufficiency ,[object Object],[object Object]
Diabetes, Hypertension and Renal Failure –Normative Aging Study ,[object Object],[object Object]
Epigenetics and Lead ,[object Object],[object Object]
Conclusion: NOW WHAT? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Lead Evaluation in a Primary Care Practice ,[object Object],[object Object],[object Object]
Check list for heavy metal symptoms used in our clinic
9,100 ug Pb/gm  Herbman/DMSA

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acam dot 2010

  • 1. Lead Toxicity ACAM April 21, 2010 Dorothy Merritt, MD This lecture is dedicated to Clair Patterson, whose inadvertant discovery of severe lead contamination in the US while trying to date the age of the Earth, lead to the Clean Air Act of 1970 and the removal of lead from gasoline for sale in the US in 1986 despite attempts of the ETHYL Corporation to get him fired from his position at Cal Tech. His persistance paid off for the betterment of society . This lecture also recognizes Thomas Midgley, an engineer whose dabbling in chemistry resulted in lead being introduced into gasoline, CFCS (chlorofluorocarbons) being unleashed on the atmosphere. His untimely death was from being strangled in a bed of pulleys he had himself invented for turning polio victims, which he himself contracted after his construction of his device. He may deserve the 20 th century’s top “Darwin Award” for removing his DNA from the pool in a most unusual way caused by his own invention.
  • 2. Lead –Who Is Affected The Most Blood-brain barrier is not complete until 6 months of age so lead can be absorbed by CNS of fetus and young child ( lead crosses placenta). Absorption of lead is estimated to be as much as FIVE TO TEN TIMES GREATER in infants and young children than in adults. Needleman H. Ann Rev Med 2004;55:209-222
  • 3.
  • 4.
  • 5.
  • 6.
  • 7. Lead glaze used on plate imported from Portugal and sold at American Home Furnishings
  • 8.
  • 9.
  • 10.
  • 11. Distribution of workers with BLLs greater than or equal to 25 µg/dL, by industry, 2003-2004 Total = 12,712 Section 44 of The Construction Chart Book, Fourth Edition, December 2007 -
  • 12. Number of workers with BLLs greater than or equal to 25 or 40 µg/dL , by detailed construction sector, 2003-2004 1,051 406 412 92 70 41 41 39 14 Section 44 of The Construction Chart Book, Fourth Edition, December 2007
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.  
  • 20.
  • 21.
  • 22.
  • 23.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36. Lead Exposure and Cardiovascular Disease A Systematic Review Ana Navas-Acien, Eliseo Guallar, Ellen K. Silbergeld and Stephen J. Rothenberg doi:10.1289/ehp.9785 (available at http://dx.doi.org/) Online 22 December 2006
  • 37.
  • 38.
  • 39.
  • 40.
  • 41. Heart rate variability as defined as autonomic dysfunction is more pronounced on high air pollution days in patients with increased bone lead Epidemiology 2008; 19; 111-120 More Lead Effects
  • 42.
  • 43. Methylation Pathways and Lead Heartfixer.com
  • 44.
  • 46.
  • 47.
  • 48.
  • 49.  
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.
  • 56. Check list for heavy metal symptoms used in our clinic
  • 57. 9,100 ug Pb/gm  Herbman/DMSA

Notes de l'éditeur

  1. Being a child is an occupational risk for lead toxicity