Colic from lead

The principles of toxicology, dose - response and individual sensitivity, are well illustrated by the metals. Historically, most of the interest and concern was with the obvious effects of metal toxicity such as colic from lead or symptoms of the Mad Hatter from mercury. The emphasis has changed to the more subtle and long-term effects and concern for potentially sensitive individuals. It is now well documented that children exposed to even low levels of lead will have a lowered IQ and other learning difficulties. This knowledge has resulted in significant changes in our use of metals. 

Acute inorganic lead poisoning is uncommon today. It usually results from industrial inhalation of large quantities of lead oxide fumes or, in small children, from ingestion of a large oral dose of lead in the form of lead-based paint chips small objects, eg, toys coated or fabricated from lead or contaminated food or drink. The onset of severe symptoms usually requires several days or weeks of recurrent exposure and manifests as signs and symptoms of encephalopathy or colic. Evidence of hemolytic anemia (or anemia with basophilic stippling if exposure has been subacute), and elevated hepatic aminotransferases may be present. 

Actions and Uses.—In excessive doses, highly poisonous in medicinal doses, it is given as a nervous stimulant in general paralysis, paraplegia, and amaurosis abo as a tonic in chorea and affections of the alimentary canal, e. y. dyspepsia, dysentery, colic arising from lead poisoning, Ac. 

Colic is also a symptom of lead poisoning in children. EPA (1986a) has identified a LOAEL of approximately 60-100 pg/dL for children. This value apparently is based on a National Academy of Sciences (NAS 1972) compilation of unpublished data from the patient groups originally discussed in Chisolm (1962, 1965) and Chisolm and Harrison (1956) in which other signs of acute lead poisoning, such as severe constipation, anorexia, and intermittent vomiting, occurred at 60 pg/dL. 

Health effects that have been associated with lead exposures during infancy or childhood include, anemia (Schwartz et al. 1990) (and related disorders of heme synthesis), neurological impairment (e.g., encephalopathy), renal alterations, and colic (Chisolm 1962, 1965 Chisolm and Harrison 1956), and impaired metabolism of vitamin D (Mahaffey et al. 1982 Rosen and Chesney 1983). Death from encephalopathy may occur with PbB levels 125 pg/dL. In addition to the above effects, the following health effects have been associated with lead exposures either in utero, during infancy or during... 

In severe lead poisoning sodium calciumedetate is commonly used to initiate lead excretion. It chelates lead from bone and the extracellular space and urinary lead excretion of diminishes over 5 days thereafter as the extracellular store is exhausted. Subsequently symptoms (colic and encephalopathy) may worsen and this has been attributed to redistribution of lead from bone to brain. Dimercaprol is more effective than sodium calciumedetate at chelating lead from the soft tissues such as brain, which is the rationale for combined therapy with sodium calciumedetate. More recently succimer (2,3-dimercaptosuccinic acid, DMSA), a water-soluble analogue of dimercaprol, has been increasingly used instead. Succimer has a high affinity for lead, is suitable for administration by mouth and is better tolerated (has a wider therapeutic index) than dimercaprol. It is licenced for such use in the USA but not the UK. 

Chronic lead nephropathy from moonshine came to medical attention because of the dramatic symptoms of acute lead poisoning. Lead colic and anemia were... 

The middle uterine, utero-ovarian or external iliac arteries may rupture during pregnancy or parturition, leading to signs of shock and colic or to the death of the mare. The therapy of rupture of these major blood vessels is somewhat controversial and may range from drugs that reduce blood pressure to those that increase circulating blood volume and pressure (Vivrette 1997). 

Gallbladder inflammation (cholecystitis) usually presents with acute abdominal pain (colic) with radiation to the right shoulder. The normal composition of bile is about 5% cholesterol, 15% phosphatidylcholine, and 80% bile salt in a micellar liquid form. Increased cholesterol from high-fat diets or genetic conditions can upset the delicate micellar balance, leading to supersaturated cholesterol or cholesterol precipitates that cause gallstone formation. Removal of the gallbladder is a common treatment for this painful condition. 

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