Document QXJOpDbQE77jBj8rkjQzLL8b5

Correspond*/)to 3 Da yl e sf o r d Ro a d, CHEADLE, CWESHtR G A TLE Y E5730" P R O F E S S O R R O N A L D E, L A N E , C .B .E , Consulting Rooms l 1 S r. J o h n St r e e t , . M a n c h e s t e r . 3. B U AC KFR IAR S 362 Professor R.A. Kehoe, Kettering Laboratory, University of Cincinatti, Ohio, U.S.A. o l La a /: During the last few months I have been discussing with some of my friends and former colleagues the broad question of the diagnosis of lead poisoning. Since there has been so much ambiguity, even in the most recent medical literature, we have decided to try and establish an acceptable and uniform basis for diagnosis and have prepared a statement which expresses our opinions as clearly ana concisely as possible. . I am attaching a copy of this statement which is self-explanatory and would greatly appreciate it if you would let me have your views. If you feel that you axe able to support the statement in its present form or perhaps after slight amendment I should be most grateful if you would allow me to add your name to the list of signatories. It is our intention to publish an agreed statement, probably in the British Medical Journal, J LwCruj '"U7) " l ^ / / // !/ ,/l/ N13927 A A + O * rJ -- V \J 1 ft i ( 4 Because of varying opinions on the' diagnosis of inorganic To; poisoning which appear in the international literature, the signatories nope that the following statcasif nay va The statement is intended to provide guidaaoi for v*.ou.icai 3 i/iii, ^ n o o ^ . i j . c o r s ai p r a c t i t i o n e r s , in the oxauir.ation of cases cf suspected io; poiso XIj uGl _a C.b.U T -1 0 S X-5 OH _L. 0 Cl C. p O l S O iu*cixn3 c.nc. supjcon'ixov _*jC.CL OiOrp elOTi S C C U l C 0 0 OC.SOCL 0X1 T.icue ciuc v*c.n1vn.nc.o'xrocs o .osor j u o .. ^rcv;r* up in relation uo iour vnicli a; v > -i u><h- _ L-v*iws. h'."k. 6X -OXHCO U*.XnCL _Ci/U. -- j----0W a---i -- w -- --ib ,,O --- .5 for estimating absorption and t . u a r / to concurrently with exposure* y, .'. ;, D) iv _ u * * i i - i e onset i*/ * ;or: Aosorpoion ioun been no occupational nornax popuaataon vaen t ab nor :r.a1 exposure. i Increased, aosorptaon rosuiting trot: occupc.tc.enu_ or a: exposure w hich is considered to be safe, and v.'hich is ; present occupationally acceptable. At these- levels o: a b s o r p t i o n the m i l d symptoms listed below, w h i c h are < ^ -------v_,_,, to a number of minor complaints, are not attributablelead. Where symptoms are reported in association wit: c c h e m i c a l test level,s s _ g n -- x c a n ~ ,, y 1v.'i t h i n a y d h VOrX U>4d.0 c e s s a t i o n oi O M j O S u r ^ * KK 0012173 N13927.01 reliable blood load levels below SO micrograns per 100 ml, ,rW it is probable that oiler causes of the symptoms have r.oi been excluded. '. | Increased absorption fro::', 'moderately excessive cccup or other exposure w hich may be associated with r.aiu . ... or signs (see below) or rarely v;itn sev^-r^ - ...J.W-V#*... These levels of absorption ever, a.: the ciom, 1<1, cl--& coi.i-- o x%' .loru;;:!; aizored sleep; Irritability; anaeir.la; Liior : blue line ; m etalli < e><dv3 L>0 1 less recuen^iy aaarrloea or nausea. M any o f 1-these are symptoms of ether, some times trivial, complaints and it is therefore essential for a correct diagnosis of lead poisoning that the symptoms and signs be associated wit! laboratory evidence of excessive absorption and that other cause bo excluded. . Severe symptoms and signs include severe intermittent abdominal pain; reduction of muscle power; muscle tenderness ; paraesthos and other symptoms or signs of neuropathy, or encepha l o p a t h y . _n a _eaa wo ricer :se are strong evidence o poisoning but, again, require supporting laboratory evidence of high lead t Cognent s The incidence of sequelae increases not only with. an increase in absorption, when the latter is excessive, ont also wi t h the 1earth of ti:ue the Vhere the results of biochemical tests, v/ith o clinical evidence, reveal moderately excessive the lead exposure should be reduced. '*0"li< i3 Vi OS vCa- 'Cif" f \ \ J ^} ht highly excessive levels of absorption (c should be removed immediately from exposure ro r - \ \ UUiViOU <\>:i%.:Add."'id bd ' ') .i'lOU TOUT A. ;; a : 1 a .\cc-.ptab.!.o blood bead -U'u) ;'g/i.oo mi. Urinary Load ( i) . < > U:ain.ary do pro po .L'phyrin 'xi-d`) ;jg/i U r:i.ua vy amino i;iO'/!t U,ii.i.o a o 1d <fi mg/j.OO ml dO'd'O yig/j.OO ml aO -.lpO ng/l 1.30 .dOO y:-/ !. 1-2 m g / .1.00 ml i;o.ly r,jrvo do -idO via/ioo 130.-U3O ^.ig/i 3 0 0 - 1,30 0 jxz/X 2-h npo/ 10 0 m Accuracy :i.r., important osipeolaJ.)./ in the da tormina, tj.ou of b lood and- urinar risk of contain .nation. o C .l. cheddn,'' v/A tU compo tout spocialis t co com m a n d e d . (.1.) Sa.JiipJ.o3 of S .(j lea:) than 1 .0 .1.0 are uiu'c.l.lab .1.o and should bo x'ojecfce Mo bos A liioacurcniont of haemoglobin i.i uaeful additional evidence; a reduced ha found iu lead poisoning and may be as soolatod with categories G or D. Punetate banophii ount a though st;i..1.1. 11aod , arc .ter; roilable than the to