A glass factory worker presented with complaints of numbness in hands and feet, generalized weakness and constipation. Radiograph showed linear lines on metaphyses of knee and wrist joints. How will you diagnose this patient?
(A) Serum mercury levels (B) Vitamin D levels (C) RBCcholinesterase levels (D) Amino levulinic acid levels in urine
(D) Ans: D. Amino levulinic acid levels in urine(Ref: Harrison 19/e p2689, 427e-2; Harper 30/e p329)High levels of lead can affect bone metabolism by combining with SH groups in enzymes such as ferrochelatase and ALA (delta-amino levulinic acid) dehrdratase.Elevated levels of protoporphyrin are found in red blood cells, and elevated levels of ALA and of coproporphyrin are found in urine.Lead Poisoning:Abdominal pain, irritability, lethargy, anorexia, anemia, Fanconi's syndrome, pyuria, azotemia in children with blood lead level (BPb) >80 i.g/ dL; may also see epiphyseal plate "lead lines" on long bone x-rays.