Occupational Health Hazards :- Metals

Metal is a general term referring to element with a typical lustrous appearance, which are good conductors of heat & electricity, & take part in chemical reaction as +ve ions (Cations). Some elements have physical properties of metals and chemical properties of non metals e.g. Toludium. Metalloids have properties intermediate between metals & non Metals e.g. Arsenic.

LEAD
There are two types of lead 1) Organic & 2) Inorganic A) Organic Lead:- Most Toxic Organic lead is TEL (Tetra Ethyl Lead), and least Toxic is TML (Tetra Methyl Lead) B) Inorganic Lead:- 1) Most Toxic is Lead Oxide 2) Least Toxic is Lead Chromate One of the most widely used metal is lead because 1) It is a heavy metal 2) Anticorrosive 3) Melting Point is low 4) Malleable 5) It can be used as alloy Uses:- 1) Lead Acid Battery 2) Alloy 3) Plumbing 4) Organic lead is used in Automotive Industry Inorganic Lead:Uptake (Absorption) :-1) Inhalation:- Inorganic lead is absorbed through inhalation (Metal Fumes) e.g. Lead Acid Battery 2) Ingestion:- Toxic particulate matter also can enter the body by ingestion, most of the time accidental, especially if the hands are not washed properly before smoking or eating. 3) Skin Absorption:- Main route of absorption is through skin & then comes inhalation. Distribution of inorganic lead in the body:- When lead enters the body it has 3 pools. 1) Rapidly Exchangeable Pool :- Mainly Blood & is responsible for the toxicity. Small amount in soft tissue. 2) intermediate Pool:- Maximum in the soft tissue 3) Skeletal Pool:- When it enters into skeletal system, it is difficult to convert body burden. Two types of Skeletal Pools:- A) Easily Exchangeable Pool:- Bone Marrow Pool & Trabicular bones. B) Slow Exchangeable Pool:- Compact bone & Dentine. Most important is a blood pool. It gives toxicity. It also gives indication of current exposure to lead. After distribution in the body it is eliminated in the urine. Urine concentration is indicative in organic lead. Small amount of inorganic lead is also eliminated through sweat, saliva & mothers milk. TEL (Tetra Ethyl Lead) is de-alkylated in the liver to Tri Ethyl form, which then spontaneously de-alkylates again to di ethyl form. This diethyl form is excreted in the bile & further de-alkylated ib the gut to ionic lead. Di-ethyl lead(DEL) is the only metabolite of tetra-ethyl form(TEL), that appears in the urine. Person may have more blood lead level but not have symptoms, then it is not considered as lead poisoning. But this is the Action Taking Step, @ 70 to 80micro Gms. At this level the person should be removed from exposure & treated. Mechanism of Action:- 1) It has very high affinity for Sulph Hydryl group (SH). Thus it is able to inhibit the activity of enzymes which depend upon SH for their proper functioning. Two main enzymes inhibited are 1) 5Amino Laevulinic Acid Dihydratase (5ALAD) & 2) Ferrochelatase. Both of them are responsible for Haem Synthesis. 2) It has got some opposite action to Calcium. So it competes with Calcium. Thus if Calcium is given it replaces lead and lead is excreted in the urine. The metabolism of lead mimics that of calcium in many respect, and it competitively inhibit the action of calcium at some important sites e.g. Synapts& During Mitochondrial Respiration. 3) Research work :-It inhibits or may affect DNA & RNA in vitro. Toxicity:- A) GIT:- Constipation followed by pain in abdomen. This pain is not relieved by antispasmodic. But just by pressing the abdomen the pain subsides. If the antidote is given the pain is reduced. -Colicky pain, Anorexia, Constipation, Dyspepsia, few may will have Diarrhoea, Bad Taste in the mouth. B) CNS:- 1) Peripheral Neuropathy, almost always motor & produce weakness of muscles mainly the long extensors of the limbs. 2) Progressive fatigue & Lithargy 3) Wrist drop & Foot drop is the typical feature 4) Organic Psychosis

5) Cerebral Oedema 6) Severe Encephalopathy with impaired consciousness, confusion known as Lead Encephalopathy. C) Renal:- 1) Severe & Progressive Renal Insufficiency along with a) Interstitial Fibrosis & b) Secondary Hypertension 2) Fanconi like Syndrome:- Mainly found in children. Characterized by a) Amino acid urea b) Glycosurea c) Hyper Phosphateurea D) CVS:-1) High B.P., 2) Increased cardiovascular disorders E) Skeletal:- 1)Arthralgia 2) Gout sometimes associated with nephropathy. Lead also interferes with normal Urate metabolism & produce Gout F) Blue Line of the Gum (Burtonian Line):- If the persons oral hygiene is not good then:H2S + PbO = PbS + H2O This Blue Line is a confirmation of of exposure but not of lead poisoning. G) Blood:- 1) Anaemia 2) Pallor, but this pallor is not because of anaemia, but due to Cutaneous Vasoconstriction 3) Basophilic Stippling or Stippled Cells found in inorganic chronic lead poisoning Other conditions where Besophilic Stippling is found are Anaemia, Cancer & Maleria H) I.Q.:- Mainly in children. I) Liver:- Cirrhosis of Liver J) Growth Arrest Line:- Band of increased density on radiograph at the growing ends of long bones & Phalanges is seen in children with lead poisoning. K) Reproductive System:- 1) In Females lead affects reproductive capacity to protect foetus. If the lead level is more than 30 microGm/DL level then the foetus suffers. 2)Males:- Lead poisoning affects the sperm quality above lead level of 40 micruGm/DL. Diagnosis:- Biochemical or Biological estimation for Blood Lead. Test Value Interpretation 1) Upto 9 MicroGm/DL Unexposed normal individual 2) 10 to 42 MicroGm/DL Acceptable level for chronic long term exposure. Retest after 6 months 3) 43 to 53 MicroGm/DL Exceedance of OSHA level. Close observation & follow up is indicated. Retest after 2 months 4) Above 53 MicroGm/DL Removal from exposure. Retest after 2 weeks. 5) Above 70 MicroGm/DL Toxic symptoms may begin to appear How to diagnosis if exposure is less than 2 weeks:1) Blood 5AIAD(5 Amino Laevulinic Acid Dihydrates) activity:- Normal is less than 6 European Units. 2)Exposure is more than 2 weeks but is less than 2 months:- Urine ALA( Amino Laevulinic Acid level. Normal is 5 mg of ALA/Gm of Creatinine. 3) Exposure is more than 2 months then ZPP which is very very important. Zinc Proto Porphyrine (ZPP):- A large scale estimate can be done by this method. WhenExposure is more than 2 months blood ZPP concentration is estimated. Normal level is 2 MicroGm/Gm of Hb. But there is a neutral period from normal level to toxic level. Toxicity is seen at 20 MicroGm/Gm of Hb. So 2 to 20 is no mans land. Treatment:-1) If signs & symptoms are seen and the blood lead level is crossing the permissible exposure limit, then the treatment to be started immediately. 2) Penicillamine Orally:- Dose 1gm/day for an adult in divided doses X 5 days. If the level dose not go down treatment may be repeated. 3) Na-Ca-Edtate:- 50 to 70 mg/Kg/day in two divided doses, as slow IV X 5 days. It will relieve the abdominal pain within few hours. 4) Other chelating agents are rarely used. 1) 3-Di Mercapto Propane Sulfonate (DMPS) 2) Di Mercapto Succinic Acid (DMSA) These two are derivatives of BAL and are less toxic.

Organic Lead:Signs & Symptoms:- 1) Abdominal discomfort & Anorexia 2) Symptoms begins with numbness in head & hands. 3) Diziness, Headache &Vertigo 4) Blurred vision specially in Dim Light 5) Heard strange sounds 6) Insomnia Biological Estimation:- 1) Blood level does not increase above 50 microGm/DL, sometimes not at all. So blood examination is useless. 2) Thus in organic lead ZPP & Porphyrin levels are measured. 3) Urine:- Urine Examination is Most Helpful. Urinary level of lead is most important Confirmatory laboratory test. Normal Level:- 150 to 350 microGm/Lit Sometimes symptoms develop much earlier than the blood levels. Treatment:- For Organic No Chelating Agent is useful. Only Dizepam is given for psychiatric treatment.