Intoxicación Por Metales (Plomo, Arsénico, Hierro)

Intoxicación por Arsénico

Etiología

• Herbicidas (trabajadores de la viña)
• Insecticidas
• Fundición de metales
• Agua contaminada (a menudo de pozos)
• Madera tratada a presión

Fisiopatología

• El arsénico hace HACE Altitude Sickness que la glucólisis produzca cero ATP neto.
• El arsénico inhibe el ácido lipoico (parte del complejo piruvato deshidrogenasa).
• Se une a los LOS Neisseria grupos sulfhidrilos
• Interrumpe la respiración celular y la gluconeogénesis

Presentación clínica

Aguda:

• General:
  • Aliento a ajo
  • Deshidratación
• Gastrointestinal:
  • Vómitos
  • Dolor Dolor Inflammation abdominal
  • Diarrea acuosa
• Cardiopulmonar:
  • Hipotensión
  • Prolongación del QT
  • Arritmias cardíacas
  • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock
  • SDRA
• Encefalopatía aguda:
  • Delirio
  • Coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma
  • Convulsiones
• Renal:
  • Proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children
  • Insuficiencia renal aguda

Crónica:

• Manifestaciones cutáneas:
  • Líneas de Mees en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las uñas (bandas blancas transversales)
  • Pigmentación (hipo o hiper)
  • Hiperqueratosis
  • Cáncer de piel (carcinoma de células escamosas)
• Neuropatía de guante de media:
  • Ardor
  • Hipersensibilidad dolorosa
  • Debilidad distal
  • Hiporreflexia
• Cáncer de hígado (angiosarcoma)
• Cáncer de pulmón
• Pancitopenia

Diagnóstico

• Sospecha a través de los LOS Neisseria antecedentes y el examen físico
• Puede observarse anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica.
• Nivel de arsénico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina
• Concentraciones plasmáticas de arsénico (útiles, pero rara vez disponibles hasta después de tomar la decisión de tratar)

Tratamiento

• Descontaminación de la piel y del tracto gastrointestinal
• Cuidados de soporte
• Terapia de quelación solo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes sintomáticos:
  • Dimercaprol Dimercaprol An anti-gas warfare agent that is effective against lewisite (dichloro(2-chlorovinyl)arsine) and formerly known as british anti-lewisite or bal. It acts as a chelating agent and is used in the treatment of arsenic, gold, and other heavy metal poisoning. Metal Poisoning (Lead, Arsenic, Iron) (1ra línea)
  • Succimer Succimer A mercaptodicarboxylic acid used as an antidote to heavy metal poisoning because it forms strong chelates with them. Metal Poisoning (Lead, Arsenic, Iron) (ácido dimercaptosuccínico ( DMSA DMSA A mercaptodicarboxylic acid used as an antidote to heavy metal poisoning because it forms strong chelates with them. Metal Poisoning (Lead, Arsenic, Iron)))
  • Unithiol Unithiol A chelating agent used as an antidote to heavy metal poisoning. Antidotes of Common Poisonings (ácido 2,3-Dimercapto-1-propanosulfónico (DMPS))
• Hemodiálisis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos graves

Intoxicación por Hierro

Etiología

• Ingestión accidental por parte de los LOS Neisseria niños ( los LOS Neisseria comprimidos de hierro pueden parecer caramelos)
• Puede ser crónico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes que requieren múltiples transfusiones de eritrocitos

Epidemiología

La toxicidad del hierro es una de las principales causas de muerte por envenenamiento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños < 6 años.

Fisiopatología

La absorción de cantidades excesivas de hierro ingerido puede provocar:

• Toxicidad celular:
  • Deterioro de la fosforilación oxidativa y disfunción mitocondrial → muerte celular
  • El hígado es el órgano más afectado.
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sobrecarga crónica, el hierro se deposita en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células del miocardio → siderosis miocárdica y muerte
• Toxicidad corrosiva:
  • El hierro es corrosivo para la mucosa gastrointestinal.
  • Conduce a síntomas gastrointestinales y a una posible pérdida de sangre

Presentación clínica

• Etapa 1: gastrointestinal
  • < 6 horas después de la ingestión
  • Náuseas
  • Diarrea
  • Dolor Dolor Inflammation abdominal
  • Gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis hemorrágica:
    • Hematemesis Hematemesis Vomiting of blood that is either fresh bright red, or older ‘coffee-ground’ in character. It generally indicates bleeding of the upper gastrointestinal tract. Mallory-Weiss Syndrome (Mallory-Weiss Tear)
    • Melena Melena The black, tarry, foul-smelling feces that contain degraded blood. Gastrointestinal Bleeding
  • Fuga capilar/ 3er espacio → hipovolemia o shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock
• Etapa 2: latente
  • 6–24 horas después de la ingestión
  • Los LOS Neisseria síntomas gastrointestinales se resuelven → el paciente parece mejorar y recuperarse
  • Algunos pacientes pueden demostrar:
    • Hipotensión
    • Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica
    • Oliguria Oliguria Decreased urine output that is below the normal range. Oliguria can be defined as urine output of less than or equal to 0. 5 or 1 ml/kg/hr depending on the age. Renal Potassium Regulation
• Etapa 3: metabólica/cardiovascular
  • 6–72 horas después de la ingestión
  • Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica
  • Síntomas cardiovasculares
    • Taquicardia
    • Hipotensión
    • Palidez
    • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock
  • Síntomas del sistema nervioso central:
    • Estupor
    • Coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma
  • Hemorragia gastrointestinal
  • Lesión pulmonar aguda o SDRA
  • Coagulopatía
  • Disfunción renal
  • La mayoría de las muertes se producen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum esta etapa.
• Etapa 4: hepática
  • 12–96 horas después de la ingestión
  • ↑ Enzimas hepáticas y niveles de bilirrubina
  • Coagulopatía
  • La hipoglucemia puede acompañar a la disfunción hepática.
• Etapa 5: retardada
  • 2–8 semanas después de la ingestión
  • Cicatrización del tracto gastrointestinal → salida gástrica u obstrucción intestinal

Diagnóstico

• Se sospecha por medio de los LOS Neisseria antecedentes y el examen físico
• Los LOS Neisseria niveles de hierro en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero confirmarán el diagnóstico.
• Estudios de apoyo:
  • ↑ Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica por brecha aniónica
  • Compruebe la función hepática, el hemograma, los LOS Neisseria factores de coagulación, la glucosa y las pruebas de función renal.
• Las imágenes abdominales pueden mostrar comprimidos radiopacos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estómago.

Tratamiento

• Estabilizar al AL Amyloidosis paciente.
• Líquidos intravenosos
• El lavado orogástrico y/o la irrigación de todo el intestino están indicados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con un número significativo de pastillas radiopacas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estómago observables mediante imagenología.
• La terapia de quelación (deferoxamina intravenosa) está indicada si se da alguno de los LOS Neisseria siguientes casos
  • Síntomas graves (alteración del estado mental, inestabilidad hemodinámica, vómitos persistentes y/o diarrea)
  • ↑ Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica por brecha aniónica
  • Concentración de hierro en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero > 500 μg/dL
  • Número significativo de píldoras en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la radiografía abdominal
• La diálisis (exanguinotransfusión o hemofiltración veno-venosa continua) está indicada si el tratamiento de quelación no mejora los LOS Neisseria síntomas del paciente.

Diagnóstico Diferencial

• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types sideroblástica: anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types microcítica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la que la médula ósea produce sideroblastos (eritrocitos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de anillo) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lugar de eritrocitos normales, de forma redonda, debido a la incapacidad del organismo para unir el hierro adecuadamente a la hemoglobina. La intoxicación por plomo inhibe la conversión de las protoporfirinas necesarias para la síntesis del hemo, lo que provoca una anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types sideroblástica.
• Esofagitis: inflamación o irritación del esófago. Los LOS Neisseria principales tipos de esofagitis son la inducida por medicamentos, la infecciosa, la eosinofílica, la corrosiva y la por reflujo ácido. Los LOS Neisseria pacientes suelen presentar odinofagia, disfagia y dolor Dolor Inflammation torácico retroesternal. El diagnóstico se realiza mediante endoscopia y biopsia. El tratamiento depende de la etiología, pero incluye medicamentos y una posible cirugía.
• Herbicidas: sustancias utilizadas para controlar el crecimiento de plantas no deseadas y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la industria de la construcción. Los LOS Neisseria diferentes tipos de herbicidas dan lugar a diferentes manifestaciones clínicas. La gestión y el tratamiento tempranos son importantes para prevenir una mayor intoxicación.
• Plaguicidas: sustancias químicas utilizadas para controlar las plagas, incluidas las malas hierbas. Los LOS Neisseria tipos más importantes son los LOS Neisseria organoclorados (diclorodifeniltricloroetano ( DDT DDT A polychlorinated pesticide that is resistant to destruction by light and oxidation. Its unusual stability has resulted in difficulties in residue removal from water, soil, and foodstuffs. This substance may reasonably be anticipated to be a carcinogen: fourth annual report on carcinogens. Insecticide Poisoning)) y los LOS Neisseria organofosforados (malatión y paratión). Los LOS Neisseria diferentes tipos de pesticidas dan lugar a diferentes manifestaciones clínicas. El manejo y el tratamiento precoces son importantes para prevenir una mayor intoxicación.