Ng c ch tr emMt vin cnh MMt vn ton cu

H Ni, Vit Namthng 11 nm 2013

Kevin C. Osterhoudt, MD, MS

Bnh vin nhiPhiladelphia

www.chop.edu

Ng c ch: Ca lm sng 1

B trai 3 tui Tin s chm pht trin

Nn tnh trng ng kinh

Ng c ch: Ca lm sng 1

Ti Khoa cp cu Nhit = 38,3 C Nhp tim = 120/pht Huyt p = 84/53 mmHg Dui cng mt no, git rung

Diazepam X 2 t ni kh qun

B trai c tnh trng ng kinh

Cng thc muBch cu 11,3 X 109/L Tiu cu 473 X 109/L Hemoglobin 6,6 g/dL (66 g/L)Hng cu c nhng chm a kim c ghinhn.

Ng c ch: Ca lm sng 1

B trai c tnh trng ng kinh

Dch no tyBch cu = 3/mm3Protein = 96 mg/dLp lc = 46 cm H2O

Ng c ch: Ca lm sng 1

Ng c ch: Ca lm sng 1

B trai c tnh trng ng kinhiu tr ban u Phenytoin, phenobarbital, midazolam Truyn pentobarbital

Nng ch trong mu = 220 g/dL (10,6 mol/L)

Ng c ch: Ca lm sng 1

B trai c tnh trng ng kinhiu tr Thuc gp ch TM/tim bp

Dimercaprol (BAL)Edetate Calcium Disodium (CaNa2 EDTA)

Hi sc cp cu X 23 ngy

Ng c ch: Ca lm sng 1

B trai c tnh trng ng kinhKt qu

CT ban uMRI ngy 22

Teo no v tiu no.Gim trng lc, ma vn, thnh lc, th

lc.

Ng c ch: Ca lm sng 2 + 3

Tr trai 13 thng tui c m t l hiu ng Xt nghim ch trong mu thng quy Ch trong mu = 47 g/dL (2,3 mol/L)

B gi ny

nng ch trong mu =200 g/dL

Ch: Cc ngun thng gp M

Cc ngunSn c ch hay gp nht!

Thi snc th do n.

ch t t ct

Ch: Cc ngun thng gp M

Cc ngunNhim trong t v khng kh

Tetraethyl ch t xngch cng nghip

Nhim ngun ncHn thic ng nc

Ch: Cc ngun thng gp M chi, thc phm, m phm, dc phm

nhp khuCh li bt cVin n/ u nGm sPin ti s dng

xem http://www.cdc.gov/nceh/lead/ Recalls/default.htm

Ch: vn quan ngi ca Vit Nam

Bc s H Ni lng u th gii viu tr ng c ch

Ch: Quan ngi t Vit Nam MNgi Vit c nguy c M

Ng c ch: Tin s

ng nc thi ch La M (476 trc cngnguyn)

Aqueduct, Segovia Spain

nc c dn bng ng t nung lnh hn ldn qua ng ch;

[ch] hy dit kh lc ca mu; Do khng nn dn dc qua ng ch nu nh

chng ta gi nc trong lnh.

Ng c ch: Tin s 2

Benjamin Franklin(sng lp, i hc Pennsylvania)

Nm 1763 m t:au qun kh -au qun bngung a -r c tay

quan st thy trn th hn ni, th sn, th sp ch.

Ng c ch: Lch s bnh

Pht hin trn tr c nguy c

Turner AJ nhng nm 1890Tr ng c ch t sn ti c.

Needleman HL nhng nm 1970Gim chc nng tr tu trn nhng tr khngtriu chng.

Ng c ch: Lch s bnh

Nhng nm 1990B Y t M

ChVn sc khe t mi trngquan trng nht tr nh.

Ng c ch: c hc

Hp thu Qua rau thai ng tiu ha ( tr em) Ht th

Phn b (cc khoang) Mu m mm ( tr em)

xng

Ng c ch: c hc 2

Thi tr Nc tiu >> dch mt

T = 1-10 thng (mu) = 10-20 nm (xng)

Ng c ch: c tnh TKTW

NngBnh no cp, tn thng neuron p lc ni sNn, l , hn m, co git

Nng thpRi lon chc nng neuron v dn truyn thn kinhKch thch, tng ngTn thng thn kinh nhn thc km gim IQ

- c th khng c triu chng i vi b m v thy thuc.

Ng c ch: c tnh TKTW 2

nng thp tn thng TK nhn thc Ch trong mu 10-44 g/dL c nghin cu

nhiu BLL lin quan n IQ

Canfield, NEJM, 2003Cho mi 1 mcg/dL ch trong mu

1,4 im IQ

Gim IQ nhiu nht khi BLL thp!

Ng c ch: nh ngha

Trung tm kim sot bnh tt M nhngha hp thu ch qu mc thay itheo tng giai on.1960s 60 g/dL1971 40 g/dL1975 30 g/dL1985 25 g/dL1991 10 g/dL2012 >5 g/dL (0,24 mol/L)

Ng c ch: Dch t hc

Ch Mt cu chuyn mi trng thnh cng?Cc bin php phi nhim Pb M:

1978Sn c ch b cm ti M

1976-1990Loi b ch t xng ti M

Ng c ch: Dch t hc 2

D liu v nng ch trong mu (BLL)Tr em 1 5 tuiNHANES II (1976-1980)

BLL trung bnh ti M 14.9 g/dLBLL > 10 g/dL (0,48 mol/L) 88%

NHANES III (1991-1994)BLL trung bnh ti M 2,7 g/dLBLL > 10 g/dL 4%

NHANES (2007-2008)BLL trung bnh ti M 1,5 g/dL

Ng c ch: Dong Mai - 2011

Cng vic hp tc

Vin lao ng v sc khemi trng,Vit Nam

v

i hcWashington,M.

Ng c ch: iu tr

Quan trng nht!Loi b kh nng tip xc ch.

Quan trng th 2!Loi b kh nng tip xc ch.

Quan trng th 3!Loi b kh nng tip xc ch.

Ng c ch: iu tr 2

Bnh s v mi trng sngNi tr sng v i hc u?B m tr lm g? C thi quen g?Dng dng, m phm nhp khu?Khc?

Cc S y t c th n nh v thanh tranguy c nhim ch.

Ng c ch: iu tr 3

Bnh s v mi trng sng

Ng c ch: iu tr 4

Gim tip xc vi ch1. Loi b nguy c nhim ch

http://www2.epa.gov/sites/production/files/documents/renovaterightbookletbwsept2011.pdf

2. Lau bi bn thng xuyn3. Gii quyt vn nc nhim ch4. n ch n b dng St, can xi

Rn luyn tr no!

Ng c ch: iu tr 5

Tin s ca Pica?Vai tr c th c ca

ty ra ng tiu ha.

Tc hp thu cach khi nut vo rut

Trc Sau l rt bin thin.ty ra ty ra

Ng c ch: iu tr 6

Cht gp ch?Pb > 70 g/dL (3,4 mol/L)

Ch nh gp ch ng tnh mch vs tiu ha.Pb 45-69 g/dL

hu ht khuyn co dng ng tiu haPb < 45 g/dL (2,2 mol/L)

gp ch c th khng c hiu qu

Khi khng c bnh no, rt t bng chng chthy ci thin kt qu khi dng gp ch d btk mc no.

Ng c ch: iu tr

Gp ch khi nng ch trong mu l 20-44 g/dL?

Rogan, NEJM, 2001780 trTt c u c lm sch ch trong mi trngChn la ngu nhin v nhm dng succimervs gi dc

Ng c ch: iu tr

Gp ch khi nng ch trong mu 20-44 g/dL?

Rogan, NEJM, 2001Miiu tr= 26 ngy

Ti 3 lniu trmt nm

Ng c ch: iu trGp ch cho nng ch trong mu 20-44

g/dL?Rogan, NEJM, 2001

Mu xm =c li khigp ch

Khng ci thin c ghi nhn trong cc test thnkinh nhn thc!

Tr c iu tr gp ch chm xu hng pht trin.

Ng c ch: Kt lun

Ch l cht c thn kinh, k c vi nng thp

Chnh sch ca chnh ph l quan trng Gnh nng do ch trong vng 40 nm ti

M. Vn cn nhiu tr b ng ch

>300.000 c lng ch trong mu > 10 g/dL tiM.

Thiu bng chng cho thy gp ch c th ltngc c nhng tn thng thn kinh.

Ng c ch: Kt lun

Ben FranklinPhng bnh hn cha bnh.

ng y ang ni vng c ch?

Xin cm n!

Philadelphia, PA, USAL k nim ngy c lp

Ng c ch: bnh no

Liu php gp ch: iu tr tng p lc ni s l cn thit BAL 75mg/M2/liu mi 4h X ~5 ngy

(Cn nhc iu tr trc bng tim BAL vidiphenhydramine.)

CaNa2EDTA 1500mg/M2/ngy qua ng truynTM lin tc X ~5 ngy.

(Lu rng iu tr bng EDTA nn c tr hon4H sau liu BAL u tin)

Da theo kinh nghim ca J. Chisolm, qua nhiu tham kho.

Ng c ch: DNG BAL

Ti M: 100 mg/ml trong ng 3 ml Ampule cha 300 mg iu tr cho b 1 tui l ~40 mg/liu Khng lu gi theo quy tc ca USP, ng

thuc m phi loi b sau khi m c 6 giU.S.P. Hng dn 797

C cht n nh nu m trong kv khun c th n nh

Ng c ch: Ti liu tham kho

Rogan WJ, et al. The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. New Engl J Med 2001; 344: 1421-6.

Canfield RL, et al. Intellectual impairment in chelation with blood lead concentrations below 10 mcg per deciliter. New Engl J Med 2003; 348: 1517-26.

CDC. Low-level lead exposure harms children: A renewed call for primary prevention. http://www.cdc.gov/nceh/lead/acclpp/final_document_010412.pdf

Ng c ch: Ti liu tham kho

U.S. Centers for Disease Control Lead Poisoning Prevention Program website.

http://www.cdc.gov/nceh/lead/

U.S. Environmental Protection Agency website regarding lead.

http://www2.epa.gov/lead

World Health Organization monograph on succimer.http://www.who.int/selection_medicines/committees/expert/1

8/applications/succimer.pdf

Thng tin khc v tc giv c quan cng tc Trung tm chng c ti Bnh vin Nhi, Philadelphia

c h tr mt phn bi Qu Cc trung tm chngc v Qu ngn sch khuyn khch ca Health Resources and Services Administration (HRSA) ca M.

Bi trinh by ny l cng son tho bi Dr. Osterhoudtv khng c hiu nh hoc bo lnh bi Bnh vinnhi Philadelphia, i hc Pennsylvania, hoc bi HRSA.

Ng c ch tr emMt vin cnh MMt vn ton cuNg c ch: Ca lm sng 1Ng c ch: Ca lm sng 1Ng c ch: Ca lm sng 1Ng c ch: Ca lm sng 1Ng c ch: Ca lm sng 1Ng c ch: Ca lm sng 1Ng c ch: Ca lm sng 1Ng c ch: Ca lm sng 2 + 3Ch: Cc ngun thng gp MCh: Cc ngun thng gp MCh: Cc ngun thng gp MCh: vn quan ngi ca Vit NamCh: Quan ngi t Vit Nam MNg c ch: Tin sNg c ch: Tin s 2Ng c ch: Lch s bnhNg c ch: Lch s bnhNg c ch: c hcNg c ch: c hc 2Ng c ch: c tnh TKTWNg c ch: c tnh TKTW 2Ng c ch: nh nghaNg c ch: Dch t hcNg c ch: Dch t hc 2Ng c ch: Dong Mai - 2011Ng c ch: iu trNg c ch: iu tr 2Ng c ch: iu tr 3Ng c ch: iu tr 4Ng c ch: iu tr 5Ng c ch: iu tr 6Ng c ch: iu trNg c ch: iu trNg c ch: iu trNg c ch: Kt lunNg c ch: Kt lunXin cm n!Ng c ch: bnh noNg c ch: DNG BALNg c ch: Ti liu tham khoNg c ch: Ti liu tham khoThng tin khc v tc gi v c quan cng tc