EP elevation

Erythrocyte protoporphyrin (EF) elevation in males Erythrocyte protoporphyrin (EP) elevation in females ALA-D inhibition... 

A dose-related elevation of EP or ZPP in lead workers has been documented extensively (Herber 1980 Matte et al. 1989). Correlations between PbB levels and log EP or ZPP indicate an apparent threshold for EP elevation in male workers at 25-35 pg/dL (Grandjean and Lintrup 1978 Roels et al. 1975) for FEP and a threshold of 30-40 pg/dL for EP (Roels and Lauwerys 1987 Roels et al. 1979). The threshold for EP elevation appears to be somewhat lower (20-30 pg/dL) in women than in men (Roels and Lauwerys 1987 Roels etal. 1975, 1976, 1979 Stuik 1974), regardless of whether exposure is primarily by inhalation (occupational) or oral (nonoccupational). These studies were controlled for possible confounding factors such as iron deficiency or age, both of which increase erythrocyte ZPP. 

FIGURE 11.6 Basic oxygen-blown flow sheet arrangements (a) stand-alone ASU (b) partially integrated ASU (c) fully integrated ASU (Gasifn — gasifier C — combustor LP — low pressure EP — elevated pressure. Courtesy of Klosek, P. et al.). 

EP - elevated piping guard vessel to limit effect of pipe mpture... 

Yip et al. (1981) were among the first to report that in young children with elevations in both PbB and EP—elevations in EP being a biomarker for both Ee deficiency and Pb exposure/toxicity—the frequency of Fe deficiency was associated with increased frequency of elevated PbB. Another earlier paper on the topic, that of Chisolm (1981), found that in 66 young children with elevated PbB and hematotoxicity indexed by elevated urinary ALA, there was an inverse relationship between chelatable Fe and chelatable Pb. Bradman et al. (2001) found that a study population of Fe-deficient California children aged 1—6 showed an inverse relationship between Fe deficiency (ferritin <12 ng/ml) and PbB, with the geometric mean PbB in the deficient children being 5.6 p.g/dl. 

In typical high-risk children, where both significantly elevated Pb exposure and marked Ee deficiency co-occur (see, for example, discussions in Marcus and Schwartz, 1987 Piomelli et al., 1982 U.S. CDC, 1985, 1991), the two factors have affected childhood Pb screening programs. In earlier Pb exposure screening periods with PbB average values of 25—30 ng/dl and higher, the recommended practice was to screen first for EP elevation and then follow up any positive results with a PbB measurement (U.S. CDC, 1978, 1985). This approach subsequently served to identify Fe deficiency in the absence of elevated PbB (false positives for PbB). At PbB levels... 

The amount of total lead in the blood can be measured to determine if exposure to lead has occurred. This test can tell if you have been recently exposed to lead. Lead can be measured lead in teeth or bones by X-ray techniques, but these methods are not widely available. These tests tell about long-term exposures to lead. Exposure to lead can be evaluated by measuring erythrocyte protoporphyrin (EP) in blood samples. EP is a part of red blood cells known to increase when the amount of lead in the blood is high. However, the EP level is not sensitive enough to identify children with elevated blood lead levels below about 25 micrograms per deciliter ( ig/dL). For this reason, the primary screening method is measurement of blood lead. For more information on tests to measure lead in the body, see Chapters 2 and 6. 

ALAD in blood is a sensitive indicator of recent exposure to lead. Urinary ALA becomes elevated at PbB levels 50 pg/dL, and is not as sensitive an indicator as ALAD. EP becomes elevated at PbB levels of 25-30 pg/dL and is a good indicator of past exposure to lead. It should be noted, however, that ALAD, ALA, and EP are not specific biomarkers for lead. 

Extrapyramidal symptoms (EPS) Dystonic reactions develop primarily with the use of traditional antipsychotics. EPS has occurred during the administration of haloperidol and pimozide frequently, often during the first few days of treatment. Neuroleptic malignant syndrome (NMS) A potentially fatal symptom complex sometimes referred to as NMS has been reported in association with administration of antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, rhabdomyolysis, and acute renal failure. 

Fish et ah, 1969 TFP 10 (10) 2-5 Childhood schizophrenia DSMTI criteria Independent blinded rater TFP 0.17-0.67 mg/day 4-15 weeks 8/10 improved with less disorganized speech and behavior Decreased irritability and hyperactivity 5/10 had mild EPS symptoms 1 child had a transient elevated SCOT 1/10 got worse... 

Pharmacologists have been attempting to define what it is about clozapine s biochemical mechanism of action that accounts for its special efficacy as well as its side effects. As discussed extensively in this chapter, SDA properties may account in part for reducing EPS, for reducing tardive dyskinesia, and perhaps even for lack of prolactin elevation SDA properties may even help explain improvement in negative symptoms of schizophrenia. However, the concept of SDA does not appear to explain the therapeutic actions of clozapine in treatment-resistant cases because clozapine is superior to other agents that share this property. 

Quetiapine also has a chemical structure related to that of clozapine (Fig. 11—36), but it has several differentiating pharmacologic (Fig. 11—41) and clinical features, not only as compared with clozapine (Fig. 11—37) but also as compared with risperidone (Fig. 11-39) and olanzapine (Fig. 11-40). Quetiapine is very atypical in that it causes virtually no EPS at any dose and no prolactin elevations. Thus, quetiapine tends to be the preferred atypical antipsychotic for patients with Parkinson s disease and psychosis. It is also useful in schizophrenia, bipolar disorder, and other types of psychosis, in which it has few extrapyramidal side effects. 

Ziprasidone has a novel chemical structure (Fig. 11—42) and a quite novel pharmacological profile as compared with the other atypical antipsychotics (Fig. 11—43). Ziprasidone appears to be atypical, like the other agents in this class, in that it has low EPS and causes little or no prolactin elevation. Its major differentiating feature... 

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