approach and management of LEAD toxicity.pptx

lead

1. LEAD By Dr Habib Bakri & Co

2. Case 45 years old production operator in a lead battery factory has been exposed to lead above PEL for past 10 years. He came to your setting and complained of abdominal pain, right upper limb muscle weakness and nausea. Investigation done and revealed that blood lead level was 75mcg/100ml

3. PEL Definition : PEL stands for permissible exposure limit or ceiling limit or an 8 hours Time Weighted Average airborne concentration PEL for inorganic lead under USECHH 2000 : 0.05mg/m3 PEL for lead exposure under FMA (Lead Regulation) 1984 150 microgram/m3 **please use full name of the legislations.

4. BEI (definition) BIOLOGICAL EXPOSURE INDICES- reference values used as guidelines for the evaluation of potential health hazards by measuring the level of determinants such as blood lead for lead poisoning.

5. BEI (description) BEI stands for Biological Exposure Indices A value used for guidance to assess biological monitoring Measure the concentration of lead in blood, urine, saliva, faeces Concept like TLV (environment), each chemical have a reasonably safe level of exposure below which significant illness, injury and discomfort may happen Sampling can be done at any point of time

6. BEI Value In blood : 30 microgram/ 100ml blood In urine : 150 microgram/ 1 gram creatinine

7. Follow up plan for the worker Employee Institute Medical Removal Protection because blood lead level is 75mcg/100ml and worker is symptomatic Repeat immediate blood lead test to confirm the blood lead level Immediate full blood count to rule out anemia (male : 11g/ dL or less ;) Treat worker symptomatically andRefer to tertiary care for chelation if needed Monitor blood lead test monthly until 2 consecutive reading of @60 mcg/100ml or less in male ; RTW assessment Retraining Return to work Assist to get compensation from SOCSO

8. Medical Surveillance Indication : Law Requirement Factories And Machinery (Lead) Regulations 1984 Occupational Safety and Health (Use and Standard of Exposure of Chemical Hazardous to Health) Regulations 2000 Employees Social Security Act 1969 Occupational Safety and Health (Notification of Accident, Dangerous Occurrence, Occupational Poisoning and Occupational Diseases) Regulations 2004 Case identified Lead above PEL History Taking : Occupational history – to know duration of work, other part time job, previous job history Social history – smoking history

9. Signs & Symptoms : CNS : drowsy, convulsion, encephalopathy, behavioural changes, peripheral neuropathy GIT : abdominal discomfort, constipation, diarrhea , nausea Renal : chronic nephritis Hemato : anemia

10. Medical Surveillance Physical Exam Pallor, burton’s line at gum , wrist drop Blood : Hb LFT NCS – nerve conduction study Blood lead Urine Urine lead

11. Action by Management (EMPLOYER) Institute Medical Removal Protection as advised by OHD Investigate cause of lead poisoning Conduct exposure monitoring and medical surveillance to the rest of the that potentially exposed to lead Conduct Training on Lead Exposure Hazard, prevention, control and identify symptoms Enforcement of legislations Re- inforcement on proper PPE compliance Assist employee in getting compensation from SOCSO Notify authority – DOSH : notify to the nearest DOSH office using JKKP form 7 via fax/email or online Record keeping not less than 30 years

12. BONUS!!!! : Definition MEDICAL SURVEILLANCE- monitoring a person for the purpose of identifying changes in health status due to occupational exposure to chemical hazardous to health . HEALTH SURVEILLANCE- necessary examination and investigation to detect exposure level and early biological effects and response which include biological monitoring, biological effect monitoring, medical surveillance, symptoms of occupational poisoning and disease as well as reviews of records and occupational history . BIOLOGICAL MONITORING- measurement and assessment of agents or their metabolites in tissues, secreta , excreta, expired air or any combination to evaluate exposure and health risk compared to an appropriate reference . BIOLOGICAL EFFECT MONITORING- sub-clinical biological effects caused by the hazards. Example FBC for anaemia in Lead poisoning . BIOLOGICAL EXPOSURE INDICES- reference values used as guidelines for the evaluation of potential health hazards by measuring the level of determinants such as blood lead for lead poisoning . PERMISSIBLE EXPOSURE LIMIT- a ceiling limit or an eight hour time-weighted average airborne concentration or the maximum exposure limit.