A case of acute lead poisoning due to intravenous injection of lead acetate is reported. The patient developed clinical and biochemical symptoms characteristic for acute hepatic porphyrias. Elevated urinary 5-aminolaevulinic acid and low porphobilinogen correlated to a lead-induced inhibition of 5-aminolaevulinic acid dehydrase with diagnostically indicative reactivation rates by zinc and dithiothreitol. Urinary coproporphyrin excretion was also increased. Additional findings included anaemia and toxic hepatitis. Under the influence of elimination therapy with D-penicillamine pathologic parameters normalized. Except for transient neuralgic pains the patient did not experience any neurologic dysfunctions, thus contrasting the findings in chronic lead intoxication.
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References
1.
Alessio, L., Castoldi, M.R., Odone, P. & Franchini, I. (1981). Behaviour of indicators of exposure and effect after cessation of occupational exposure to lead. Br. J. Ind. Med., 38, 262.
2.
Beattie, A.D., Briggs, J.D., Canavan, J.S.F., Doyle, D., Mullin, P.J. & Watson, A.A. (1975). Acute lead poisoning. Q. J. Med. (New Series), 44, 275-284.
3.
Berlin, A. & Schaller, K.H. (1974). European standardized method for the determination δ-aminolevulinic acid dehydratase in blood . J. Clin. Chem. Clin. Biochem., 12, 389-390.
4.
Bonkowsky, H.L. & Schady, W. (1982). Neurologic manifestations of acute porphyria. Semi. Liver Dis., 2, 108-124.
5.
Brearley, R.L. & Forsythe, A.M. (1978). Lead poisoning from aphrodisiacs: potential hazard in immigrants. Br. Med. J., 542, 1748-1749.
6.
Dagg, J.H., Goldberg, A., Lochhead, A. & Smith, J.A. (1965). The relationships of lead poisoning to acute intermittent porphyria. Q. J. Med. (New Series), 34, 163-175.
7.
Dickinson, L., Reichert, E.L., Ho, R.C.S., Rivers, J.B. & Kominami, N. (1972). Lead poisoning in a family due to cocktail glasses . Am. J. Med., 52, 391-394.
8.
Doss, M. (1974). Porphyrins and porphyrin precursors. In Clinical Biochemistry, eds H. Ch. Curtius & M. Roth, pp. 1325-1371. Berlin/New York: De Gruyter .
9.
Doss, M. (1978). Relationships between acute hepatic porphyrias due to genetic variability of primary enzyme defects and limiting function of uroporphyrinogen synthase. Int. J. Biochem., 9,911-916.
10.
Doss, M. (1979). Haematological disturbances of porphyrin metabolism . In Strategies in Clinical Haematology, eds R. Gross & K. P. Hellriegel , pp. 97-109. Berlin/HeidelbergNew York: Springer.
11.
Doss, M. (1984). Hepatitis durch Bleivergiftung. Dtsch. Med. Wochenschr., 109, 1007-1008.
12.
Doss, M. & Müller, W.A. (1982). Acute lead poisoning in inherited porphobilinogen synthase (δ-aminolevulinic acid dehydrase) deficiency. Blut, 45, 131-139.
13.
Doss, M., Laubenthal, F. & Stoeppler, M. (1984). Lead poisoning in inherited δ-aminolevulinic acid dehydratase deficiency. Int. Arch. Occup. Environ. Health , 54, 55-63.
14.
Filippini, L. & Simmler, F. (1980). Blei-Intoxikation durch Schnupftabak. Dtsch. Med. Wochenschr., 109, 1504-1506.
15.
Fischbein, A., Wallace, J., Anderson, K.E., Sassa, S., Kon, S., Rohl, A.N. & Kappas, A. (1982). Lead poisoning in an art conservator. Am. J. Med., 247, 2007-2009.
16.
Graben, N., Doss, M., Kloppel, H.A., Wilhelms, W. & Tiepermann, R. Von (1978). Therapy for lead poisoning . In Diagnosis and Therapy of Porphyrins and Lead Intoxication , ed. M. Doss, pp. 211-216. Berlin /Heidelberg/New York: Springer.
17.
Green, R.A., Selby, L.A. & Zumwalt, R.W. (1978). Experimental lead intoxication in dogs: a comparison of blood lead and urinary delta-aminolevulinic acid following intoxication and chelation therapy. Can. J. Comp. Med., 42, 205-213.
18.
Kusell, M., Lake, L., Andersson, M. & Gerschenson, L.E. (1978). Cellular and molecular toxicology of lead. II. Effect of lead on δ-aminolevulinic acid synthetase of cultured cells. J. Toxicol. Environ. Health, 4, 515-525.
19.
Lewin, L. (1920). Die Gifte in der Weltgeschichte: Toxikologische, allgemeinverständliche Untersuchungen der historischen Quellen. Berlin: Verlag Julius Springer.
20.
Lilis, R., Fischbein, A., ANDERSON, H. A., ROM, W., RICE, C., SARKOZI, L., KON, S. & SELIKOFF, I. (1977). Prevalence of lead disease among secondary smelter workers and biological indicators of lead exposure. Environ. Res., 14, 255-285.
21.
Loi, F., Battista, G., Malentacchi, G.M., Paradiso, G., Pompelia, A., Rubegni, M. & Federico, A. (1981). Familial lead poisoning from contaminated wine . Ital. J. Neurol. Sci., 2, 283-290.
22.
Mauzerall, G. & Granick, S. (1956). The occurrence and determination of δ-aminolevulinic acid and porphobilinogen in urine. J. Biol. Chem., 219, 435-446.
23.
Meyer, U.A. (1978). Regulation of heme biosynthesis in hepatic and erythroid cells: a brief introduction to the pathobiochemistry of human porphyrias and lead intoxication. In Diagnosis and Therapy of Porphyrias and Lead Intoxication, ed. M. Doss, pp. 3-7. Berlin/Heidelberg/ New York : Springer.
24.
Molina-Ballesteros, G., Zuniga-Charles, M.A., Sanchez-Anzaldo, F.J. & Gonzalez-Ramirez, J.D. (1978). Urinary δ-aminolevulinic acid as a biological indicator throughout penicillamine therapy in lead intoxication . Arch. Environ. Health, 33. 308-313.
25.
Moore, M.R. & Meredith, P.A. (1976). The association of delta-aminolevulinic acid with the neurological and behavioural effects of lead exposure. In Trace Substances in Environmental Health, ed. D. D. Hemphil, pp. 363-371. X. Columbia: University of Missouri.
26.
Myers, R.R., Powell, H.C., Shapiro, H.M., Costello, M.L. & Lambert, P.W. (1980). Changes in endoneural fluid pressure, permeability and peripheral nerve ultra-structure in experimental lead neuropathy. Ann. Neurol., 8, 392-401.
27.
Okamoto, Y. & Kawai, M. (1984). An association between increased porphyrin precursors and onset of abdominal symptoms in lead poisoning. Toxicol. Lett., 21, 219-223.
28.
Russell, V.A., Lamm, M.C.L. & Taljaard, J.J.F. (1982). Effects of δ-aminolevulinic acid, porphobilinogen and structurally related amino acids on 2-deoxy-glucose uptake in cultured neurons. Neurochem. Res., 7, 1009-1022.
29.
Schlegel, H. & Kufner, G. (1979). Long-term observation of biochemical effects of lead in human experiments. J. Clin. Chem. Clin. Biochem., 17, 225-233.
30.
Seppalainen, A.M., Hernberg, S. & Kock, B. (1979). Relationship between blood lead levels and nerve conduction velocities. Neurotoxicology, 1, 313-332.
31.
Silbergeld, E.K., Fales, J.T. & Goldberg, A.M. (1974). The effects of inorganic lead on the neuromuscular junction. Neuropharmacology, 13, 795-801.
32.
Triebig, G. (1984). Schwere Blei-Polyneuropathie. Verlauf und Prognose. Fortschr. Med., 102, 485-488.
