Biochemistry of Poisoning
In the human body, lead inhibits porphobilinogen synthase and ferrochelatase, preventing both porphobilinogen formation and the incorporation of iron into protoporphyrin IX, the final step in heme synthesis. This causes ineffective heme synthesis and subsequent microcytic anemia. At lower levels, it acts as a calcium analog, interfering with ion channels during nerve conduction. This is one of the mechanisms by which it interferes with cognition. Acute lead poisoning is treated using disodium calcium edetate: the calcium chelate of the disodium salt of ethylene-diamine-tetracetic acid (EDTA). This chelating agent has a greater affinity for lead than for calcium and so the lead chelate is formed by exchange. This is then excreted in the urine leaving behind harmless calcium. According to the Agency for Toxic Substance and Disease Registry, a small amount of ingested lead (1%) will store itself in bones, and the rest will be excreted by an adult through urine and feces within a few weeks of exposure. However, only about 32% of lead will be excreted by a child.
Exposure to lead and lead chemicals can occur through inhalation, ingestion and dermal contact. Most exposure occurs through ingestion or inhalation; in the U.S. the skin exposure is unlikely as leaded gasoline additives are no longer used. Lead exposure is a global issue as lead mining and lead smelting are common in many countries. Most countries have stopped using lead-containing gasoline by 2007. Lead exposure mostly occurs through ingestion. Lead paint is the major source of lead exposure for children. As lead paint deteriorates, it peels, is pulverized into dust and then enters the body through hand-to-mouth contact or through contaminated food, water or alcohol. Ingesting certain home remedy medicines may also expose people to lead or lead compounds. Lead can be ingested through fruits and vegetables contaminated by high levels of lead in the soils they were grown in. Soil is contaminated through particulate accumulation from lead in pipes, lead paint and residual emissions from leaded gasoline that was used before the Environment Protection Agency issue the regulation around 1980. The use of lead for water pipes is problematic in areas with soft or (and) acidic water. Hard water forms insoluble layers in the pipes while soft and acidic water dissolves the lead pipes. Inhalation is the second major pathway of exposure, especially for workers in lead-related occupations. Almost all inhaled lead is absorbed into the body, the rate is 20–70% for ingested lead; children absorb more than adults. Dermal exposure may be significant for a narrow category of people working with organic lead compounds, but is of little concern for general population. The rate of skin absorption is also low for inorganic lead.
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