The Clinical Spectrum of Plumbism; an Experience from a Tertiary Care Hospital in Karachi, Pakistan

Background: lead toxicity continues to remain a concerning health problem for developing nations like pakistan. due to the lack of studies, we aim to highlight the clinical spectrum of lead poisoning in patients presenting to an urban-based tertiary care hospital in pakistan. method: this is a retrospective review of patients admitted form january 2011 to december 2014 using a structured questionnaire for recording demographics, comorbidities, clinical findings, biochemical abnormalities, clinical findings and treatment provided. patients were categorized as children (≤18yrs) and adults (>18yrs), further divided into three groups; desired blood lead levels (blls) [lead levels <2ug/dl in children and <10ug/dl in adults], high but non-toxic [children 2-10ug/dl, adults 10-70ug/dl] and toxic [children >10ug/dl, adults >70ug/dl]. results: a total of 86 patients were included in the final analysis, majority (69.6%) of whom were adult males with median age of 35 yrs. median (iqr) bll was 6.3 ug/dl (12.8-2.7) in all age groups with bll in children and adults of 4.2 ug/dl (3.1-5.7) and 6.5 ug/dl (2.6-14.7), respectively. 72% of the children had complaints related to the central nervous system with majority complaining of irritability. the gastrointestinal system was most commonly implicated in adults (93%) with most common complaint of abdominal pain. the commonest risk factor showing a positive correlation with blls was battery handling in adults [median (iqr) bll 18.4ug/dl (8.35-36.1)] and pica eating in children with blls in high but non-toxic range [median (iqr) bll 5.2ug/dl (2.7-5.7)]. the highest blls were observed to lie within the high but non-toxic range group in one adult herbal medicine user (54.4 ug/dl) and in children observed in the toxic range group (>10ug/dl) due to occupational battery work exposure and residence in a congested zone. conclusion: lead toxicity continues to be hazardous due to unchecked environmental and occupational exposure. increasing awareness is tantamount in order to find a solution.