Heavy metals

1. Lead Poisoning (Pb)

⚠️ MCQ Focus: Clinical & Hematological Findings

• Lead Colic vs. Acute Appendicitis (Vital Differentiation)
• • Lead Colic: Severe abdominal pain that is relieved by deep pressure.
  • • Note: The patient feels relief when you press on their abdomen.
  • Appendicitis: Pain increases with pressure, associated with rebound tenderness and rigidity.
• Chronic Poisoning in Children (Plumbism)
• • Often associated with a history of Pica (e.g., licking lead-painted toys or eating wall paint).
  • Hematological Triad (MCQ):
  • 1. Microcytic Hypochromic Anemia.
    2. Basophilic Stippling (Punctuate Basophilia): Aggregation of RNA in RBCs.
    3. Reticulocytosis.
• Diagnostic Signs:
• • Gums: Blue-black Burtonian line (Lead sulfide) on the gum margin.
  • Kidney Pathology: Causes Chronic Interstitial Nephritis (MCQ distinction).
  • Nerves: Wrist drop and foot drop (Motor peripheral neuritis).

2. Mercury Poisoning (Hg)

⚠️ MCQ Focus: Kidney & Signs vs. Lead

• Renal Pathology (Distinction from Lead):
• • Mercury: Causes Nephrotic Syndrome (due to membranous glomerulonephritis).
  • Contrast: Lead causes Interstitial Nephritis.
• Diagnostic Signs:
• • Gums: Gray line on the gums (deposition of mercury excreted in saliva).
  • Tremors: Fine intention tremors (Danbury tremors).
  • Psychic: Erethism (shyness, loss of memory, irritability).

3. Iron Poisoning (Fe)

⚠️ Written Question Alert: "Enumerate the 5 Stages of Acute Toxicity" (Previous Year Question)

1. Stage 1 (GI Irritation):
2. • Timing: Within 6 hours post-ingestion.
   • Signs: Severe vomiting (hematemesis), bloody diarrhea (melena), and abdominal pain due to direct mucosal corrosion.
2. Stage 2 (Quiescent/Latent Stage):
3. • Timing: 6–12 hours up to 2 days.
   • Signs: Apparent clinical recovery as iron is taken up by the reticuloendothelial system.
3. Stage 3 (Circulatory Shock & Acidosis):
4. • Timing: After 2 days.
   • Signs: Shock, severe metabolic acidosis, hypoglycemia, fever, and leukocytosis.
4. Stage 4 (Hepatorenal Failure):
5. • Timing: Starts after a few days.
   • Signs: Jaundice (liver necrosis), bleeding tendency (hypoprothrombinemia), and renal failure.
5. Stage 5 (GI Obstruction):
6. • Timing: 2–5 weeks later.
   • Signs: Gastric scarring leads to pyloric stenosis and intestinal obstruction.

🧪 Specific Antidote (MCQ):

• Deferoxamine (Desferal):
• Effect: It turns the urine into a "Vin Rose" (pink/red wine) color, indicating the excretion of iron complex.

4. Arsenic Poisoning (As)

⚠️ MCQ Focus: Arsenic vs. Cholera

• Differential Diagnosis:
• • Acute Arsenic Poisoning: Vomiting precedes Diarrhea. The pain is colicky, and there is a throat constriction sensation.
  • Cholera: Diarrhea precedes Vomiting. The diarrhea is painless.
  • Commonality: Both present with "Rice-water stools"