27661040 Visualization

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