SAQ. A 35-year-old man painter by occupation has presented with history of nonspecific abdominal pain, headache and difficulty in concentrating in his activities. On examination he is moderately anemic with no organomegaly. 

Most likely diagnosis is chronic occupational lead poisoning 

1. Mention other physical signs in favor of your diagnosis.

1. BP- increased
2. Anemia
3. Gum: gray lead lines 
4. Abdomen –  tender
5. Motor Neuropathy →decreased Jerks & power.
6. Features of hypocalcemia →Tetany carpopedal spasm

1. Enumerate 1 investigation to confirm the diagnosis.

• Blood lead concentration

1. Mention the management plan.

• Prevent further exposure 
• Supportive therapy:

1. Fluid, Electrolyte, Nutrition
2. BT (if needed)
3. Chelation therapy with DMSA or Sodium calcium edetate.

Tips:

• The clinical presentation can resemble that of acute intermittent porphyria (Chap. 416), including elevated levels of urine porphyrins as a result of the inhibition of δ-aminolevulinic acid dehydrase. 
• Chelation therapy;

1. ethylenediamine tetraacetic acid (EDTA).
2. DMSA or Sodium calcium edetate.

Clinical features:

• Fatigue, depression, and confusion 
• episodic abdominal pain and peripheral neuropathy. 
• Gray lead lines  in the gums, 
• anemia with basophilic stippling of red blood cells.