Nurse Nancy is teaching Mr. and Mrs. Diaz about the early signs and symptoms of lead poisoning. Which of the following if stated by the couple would indicate the need for further understanding of the case?
A. Anemia
B. Seizures
C. Irritability
D. Anorexia
Correct Answer: B. Seizures
Seizures usually are associated with encephalopathy, a late sign of lead poisoning. Typically, lead levels have already exceeded 70 mg/dl. In the appropriate clinical setting, lead encephalopathy should be considered in patients presenting with delirium, altered mental status, or seizures. As lead encephalopathy often presents with altered sensorium, obtaining a history directly from the patient can be challenging.
Option A: Key features of the patient’s history that should raise the index of suspicion for lead encephalopathy may include associated abdominal pain, constipation, or anemia, which are other common findings of lead intoxication.
Option C: Particularly in sub-acute cases, additional history of preceding ataxia, headache, sensory or motor deficits, agitation, or irritability may be present. Finally, obtaining a detailed environmental history is important in understanding the route and magnitude of potential lead intoxication.
Option D: A physical exam will primarily reveal CNS derangement. Generally speaking, patients afflicted with lead encephalopathy will appear to be globally altered. They may also exhibit signs of peripheral neuropathy on the exam, such as wrist drop and loss of 2 point discrimination.