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The Need for Expert Clinical Assessments in Diagnosis Of Heavy Metal Poisoning

Isla MacGregor - Toxic Heavy Metals Taskforce Tasmania

With considerable research and advice from several medical and specialist experts the Toxic Heavy Metals Taskforce Tasmania has developed an understanding of the importance of the need for thorough expert clinical assessments with patients to confirm the diagnosis of heavy metal poisoning.

Many elements and heavy metals are quite toxic to humans even in low doses. However, the "metabolism" of the element or heavy metal in the human body depends on the type of element or heavy metal. In particular some metals are "excreted" mostly by the kidney whereas others are metabolized (or detoxified) mostly by the liver.

In the case of arsenic, there is evidence that this element passes "through" the body on a single exposure reasonably quickly (i.e. 1 -4 days). So in the case where there has been low dose but repeated exposures, simply measuring the urine (usually the most successful option) or blood measurement, does not necessarily tell the full story unless the exact time of exposure is "available".

In the case at Rosebery, the problem is that, whilst it is probable that there is repeated exposure of low to moderate dose metals such as arsenic, the exact time of the exposure is difficult to ascertain in the individual case.

Hair analysis is helpful in identifying whether there has been exposure to a particular metal or element but the time of the exposure is more difficult to interpret.

The clinical signs of arsenical poisoning also have a peculiar feature in that some people react in different ways despite very similar exposures. This may well account for the fact given similar exposure some patients appear to show more advanced clinical signs.

The term 'toxicologist' is often used in problems where there has been pollution in the environment which is effecting human health. Unfortunately this term 'toxicologist' is in fact quite confusing because there is always a tendency to assume that the 'toxicologist' has experience and training in the medical and clinical aspects of poisoning in humans. This is not always the case. For example, many toxicologists have training in non medical fields such as pure chemistry or pharmacology. Whilst the analysis of chemicals from a scientific point of view is important, the disease pattern, or more specifically the effect on human health, must have input also from an expert in clinical medicine with hands on experience with heavy metals.

However, clinical medicine can be just as important if not more important in diagnosing the type of poisoning that has occurred in Rosebery. In this instance clinical medicine would include: taking a careful history of "occupational exposure and lifestyle history", past history of previous medical conditions, a careful, thorough and full examination of the patient and where required further examination of the patient eg general tests such chest xrays, non specific blood tests such as full blood counts and where appropriate to refer the patient to a specialist such as a neurologist, dermatologist or gastroenterologist.

At the end of the day, long term clinical effects of metals such as arsenic are known to have specific and identifiable clinical manifestations eg with arsenic the patient may show a peculiar staining of the skin and patterns of tumors some of which are cancerous. Damage to the nerves also shows a typical pattern of injury to the sensory and motor components of the nerve.

Without doubt, a specialist doctor with hands on experience with heavy metals is absolutely required to recognise these signs and symptoms.

Even then, that specialist may have to rely on a sophisticated examination such as a nerve biopsy. In overseas cases, especially when many people have been shown to have exposure to a toxic heavy metal such as arsenic it was not possible to carry out full chemical testing for each patient. Despite this the doctors involved were confident of the diagnosis. The pattern of exposure, the history of the onset of the symptoms in the person and the signs observed by the doctor are then "diagnostic" in themselves.

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The LEAD Group Inc. Fact Sheet Index

NSW Lead Reference Centre and NSW Government Publications On this site

  1. About the Global Lead Advice and Support Service (GLASS)

  2. Main Sources of Lead

  3. How Would You Know If You or Your Child Was lead poisoned?

  4. Lead aware housekeeping

  5. Ceiling dust & lead poisoning

  6. Is your yard lead safe?
    你的院子是铅安全的吗

  7. Health Impacts of lead poisoning

  8. Rotary Questionnaire

  9. Lead poisoned Pets and Your Family

  10. Childhood Lead Poisoning Risk Factor Questionnaire

  11. Is Your Child Safe From Lead? - What Can You Do About Lead?

  12. Lead in Drinking Water in Australia

  13. Have We Really Resolved The Lead Issue?

  14. The Importance of the Availability of "Spot Tests" for Lead in Paint

  15. Pregnant or Planning a Pregnancy

  16. Breastfeeding and Lead

  17. Lead in breast milk

  18. Beware The Lead In Lead Lighting

  19. Renting and Lead

  20. What to do if you have too much lead in your tank water

  21. Lead Contamination in Stormwater

  22. Contamination At Shooting Ranges

  23. Banned: Leaded Wick Candles

  24. Lead, Ageing and Death
    铅,衰老和死亡

  25. Metal miniatures: How to minimise the risks of lead poisoning and contamination

  26. 7 Point Plan for the MANAGEMENT OF LEAD by Australian parents and carers

  27. Countries where Leaded Petrol is Possibly Still Sold for Road Use, As at 17th June 2011

  28. Lead Poisoning And The Brain - Cognitive Deficits And Mental Illness

  29. Facts and Firsts of Lead

  30. Lead mining royalties by state and territory

  31. Lead Mining Stewardship - Grey Lead and the Role of The LEAD Group

  32. Preventative Strategies of The LEAD Group

  33. What do Doctors need to do about Lead?

  34. A Naturopath's Experience Of Lead & People With Diagnosed Mental Illness

  35. Case File: Helping Manage Australian Lead in Petrol - How GLASS Works

  36. Glass Web & Service-Users, Experts & Volunteers, by Country; Countries with Leaded Petrol for Road Use & Worst Pollution

  37. Lead in ceiling dust

  38. Lead paint & ceiling dust management - how to do it lead-safely

  39. Esperance parliamentary inquiry follow-up factsheet: Where to from Here??
    埃斯佩兰斯议会调查后续情况说明书:从这里去哪里??

  40. Broken Hill lead miners factsheet 1893 with Note 20081015

  41. Helping a Doctor Help 35,000 Lead-Poisoned People Around the Lead Smelter at La Oroya in Peru
    Ayuda a un doctor que ayuda 35,000 personas envenenadas por plomo alrededor de la fundidora de plomo en la Oroya-Peru
    案例档案:帮助一个医生救助在秘鲁的拉奥罗亚的铅冶炼厂周围的35000铅中毒的人民全球铅咨询和支持的服务机构是怎末工作的

  42. Fact sheet for Australian toy importers and traders

  43. Iron Nutrition & Lead Toxicity
    Informe de Acciones – Hierro y Plomo en la Nutrición
    情况说明书铁的营养和铅的毒性

  44. Sanitarium-Are You getting Enough Iron

  45. Do-It-Yourself-Lead-Safe-Test-Kits-flyer

  46. Blood lead testing: who to test, when, and how to respond to the result

  47. Dangers of a blood lead level above 2 µg/dL and below 10 µg/dL to both adults and children
    血铅水平高于
    2微克/分升和低于10微克/分升对予成人和儿童的危险。

  48. Lead Exposure & Alzheimer’s Disease: Is There A Link?

  49. In CHINA - Blood lead testing: who to test, when, and how to respond to the result
    在中国血铅测试:谁应该去检查,什么时候,如何对待不同的测试结果

  50. Why you should have your ceiling dust removed before you take advantage of the Australian government's Energy Efficient Homes Package: Insulation Program

  51. Alperstein et al Lead Alert - A Guide For Health Professionals 1994

  52. Ceiling Dust WorkCover Guide Lee Schreiber Final Nov 1999

  53. What can I do about climate change AND lead?

  54. The Need for Expert Clinical Assessments in Diagnosis Of Heavy Metal Poisoning

  55. Why you should have your ceiling dust removed before you have insulation installed

  56. Thirty Thought-Starters on Ceiling Void Dust in Homes

  57. Pectin: Panacea for both lead poisoning and lead contamination

  58. Nutrients that reduce lead poisoning June 2010

  59. Lead poisoning and menopause

  60. Fact sheet For Schoolkids From Professor Knowlead About Lead

  61. Prevention of Exposure to Lead at Work in Indonesia

  62. Mencegah kontak dengan timbal di tempat kerja di Indonesia

  63. How to Protect Your Family from Lead in Indonesia

  64. Bagaimana melindungi keluargamu dari timbal di Indonesia

  65. Cigarette Smoking & Lead Toxicity
     صحيفة معلومات: التدخين والتسمم بالرصاص

  66. Medical Evaluation Questionnaire For Occupational Lead Exposure

  67. Dangers of a blood lead level above 2 µg/dL and below 10 µg/dL to children

  68. Dangers of a blood lead level above 2 µg/dL and below 10 µg/dL to adults

  69. Biosolids used as fertilizer in China and other countries
    在中国和其他国家生物固体作肥料

  70. What are the lead poisoning risks of a lead pellet, bullet or shot lodged in the body?

  71. Alcohol’s link to higher lead and iron levels

  72. USA Case Definition of Adult (including Occupational) & Child Elevated Blood Lead Levels (EBLL)

  73. Low Level Lead Exposure Harms Children - A Renewed Call for Primary Prevention

  74. Occupational Health & Safety Fact Sheet Dangers of lead for roofers

  75. Let’s Make Leaded Petrol History - Let’s Make Leaded Gasoline History

  76. Lead, Your Health & the Environment. Available in Arabic, Chinese, English, Korean, Macedonian, Spanish, Turkish and Vietnamese 

  77. Lead Safe Housekeeping

  78. Old Lead Paint

  79. Working safely with lead

  80. A Renovator's Guide To The Dangers Of Lead (Brochure 30 pages)

  81. A Guide For Health Care Professionals (Brochure 34 pages)

  82. A Guide To Keeping Your Family Safe From Lead (Brochure 20 pages)

  83. Lead Hazard Management In Children's Services (Brochure 15 pages)

  84. A Guide To Dealing With Soil That Might Be Lead-Contaminated

  85. Exposure Assessment: Lead Neurotoxicity - Is the Center for Disease Control's goal to reduce lead below 10 µg/dl blood in all children younger than 72 months by 2010, good enough?

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