--- a
+++ b/processing/MACCROBAT/27661040.txt
@@ -0,0 +1,25 @@
+We present the case of a 16-year-old girl, admitted to our clinic with severe abdominal pain, loss of appetite, nausea, and vomiting.
+The anamnesis revealed that the girl comes from a family of potters, and that she also participated in the process of pottery, her father being diagnosed with lead poisoning 2 years before.
+The patient's personal history underlined that approximately 1 year ago she presented with severe abdominal pain, being diagnosed with acute appendicitis and she underwent appendectomy, but the pain persisted, thus due to family history of lead poisoning, the suspicion of saturnine colic rose, and she was diagnosed with lead poisoning (urinary lead: 219 μg/L), but she received only symptomatic treatment.
+Approximately 3 weeks before admission to our clinic, she was admitted to the regional hospital with another episode of saturnine colic (blood lead: 113.2 μg/dL), and chelation therapy with EDTA (4 days before the admission in our clinic) was initiated, with a dose of 2 tablets daily, one in the morning and one in the evening associated with calcium supplements.
+The clinical examination performed at the time of admission revealed the following pathological elements: influenced general status, ailing face, jaundice of the sclera, blue pigmentation of the nails, painful abdomen at palpation, and weight: 45 kg.
+The laboratory test performed upon admission revealed hypochromic anemia (hemoglobin (Hb): 10.9 g/dl, hematocrit (Htc): 31.6%, medium cellular volume (MCV): 77.6 fL), increased level of liver transaminases (alanine-aminotransferase (ALAT): 158.9 U/L, aspartate-aminotransferase (ASAT): 63 U/L, gamma-glutamyl-transferase (GGT): 128 U/L), conjugated hyperbilirubinemia (direct bilirubin (DBi): 1.432 mg/dL), hyponatremia (Na: 132 mmol/L), and hypopotassemia (K: 2.85 mmol/L).
+The systolic arterial pressure was 156 mm Hg, and the diastolic was 96 mm Hg.
+The blood lead level was 66.28 μg/dL, the urinary one was 419.7 μg/L (normal <50 μg/L) and the value of delta-aminolevulinic acid was 7.66 mg/L (normal <4.5 mg/L).
+We also performed abdominal ultrasound which revealed a disappearance of the delimitation between the cortical and medullar parts in both kidneys.
+We requested consultation from an occupational healthcare specialist, who recommended the continuation of chelation therapy with EDTA, increasing the dose at 4 tablets/day.
+We also required a neurological consultation, and the specialist established the diagnosis of behavioral disorders with depressive elements, and recommended psychotherapy.
+Based on all these clinical and laboratory findings, we established the diagnosis of lead poisoning.
+We initiated an intense i.v. hydration in order to favor lead elimination, approximately 3 liters per 24 hours initially, and we decreased progressively the quantity once she ceased to vomit, and she was able to consume liquids.
+We associated diuretics, initially furosemide by vein, but the values of the arterial pressure persisted above the upper limit, therefore we were forced to introduce also an angiotensin-converting enzyme inhibitor, with the remission of arterial hypertension.
+Regarding the liver function, we administered amino acids intravenously, associated with liver protectors by mouth.
+We also administered vitamins of the B complex in order to improve the neurological impairment.
+The evolution was slightly favorable, in the first 3 days after the admission, the patient continued to present severe abdominal pain, vomiting, and she also complained of pain in the lumbar area.
+All the laboratory parameters presented normalization of the values after approximately 10 days of treatment.
+On the 6th day of admission, we ceased the chelation therapy with EDTA.
+We also repeated the blood and urinary lead levels.
+The blood level was 45.57 μg/dL, and the urinary one was 836.4 μg/L before discharging the patient.
+The abdominal ultrasound reevaluation revealed no pathological modifications.
+After 14 days of admission, the patient was discharged without any complaints, and we recommended no further exposure to lead, avoiding the contact and the working in the pottery process.
+The long-term outcome of this case depends on further exposure to this heavy metal.
+Nevertheless, we intend to repeat the blood lead levels after 12 and 24 months, assessing also the renal (urea, creatinine, urinary exam) and hepatic functions (ASAT, ALAT, GGT, bilirubin).