By Michael R Dobbs
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27 Chapter 3 • Approach to the Outpatient with Suspected Neurotoxic Exposure 10 g/dL is cause for concern, but like many neurotoxins, actual levels for toxicity are not known and may vary. It is noteworthy that in adults 20 g/dL is the threshold for neurotoxicity, and encephalopathy is usually not seen until levels of 100 g/dL are reached. Testing a hemogram may show a microcytic hypochromic anemia. Chemistry proﬁles may reveal uric acid derangements or other abnormalities. Uric acid is usually low in lead-poisoned children, while it is high in lead-poisoned adults.
4 A safe and efﬁcient method of cooling is evaporative cooling using water misting and large fans. Active cooling should be continued until the patient’s core temperature is 39°C. 5,6 Health-care providers have a low threshold to consider carbon monoxide (CO) exposure in the patient presenting with altered mental status. CO is a relatively common, potentially deadly, and easily missed poisoning. Patients can be exposed in multiple ways. 7 Individuals may also intentionally expose themselves to CO as a method of suicide.
Testing a hemogram may show a microcytic hypochromic anemia. Chemistry proﬁles may reveal uric acid derangements or other abnormalities. Uric acid is usually low in lead-poisoned children, while it is high in lead-poisoned adults. Historically, it is believed that much of the ancient Roman aristocracy suffered from gout due to lead exposure. Lead may also cause liver or kidney damage. Radiographs of the abdomen may show lead foreign bodies. Radiographs of long bones may show characteristic ﬁndings of lead poisoning.