Lead Poisoning-An Often Overlooked Cause of Abdominal Pain

鉛中毒－一個易被忽略的腹痛原因

10.7023/TJFM.200503.0046

林乃凡(Nai-Fan Lin)；黃百粲(Pai-Tsang Huang)

lead poisoning ； abdominal pain

台灣家庭醫學雜誌

15卷1期（2005 / 03 / 01）

46 - 53

英文

鉛中毒性腹痛為一罕見，但在台灣社會仍然可以發現的疾病。不熟悉這個疾病將導致延誤或誤診，不適當的處置，並使病人持續暴露在有毒的環境中。個案是一位鉛電池工廠員工，因為反覆性腹痛、噁心、嘔吐、體重減輕而來求診。由於醫師的警覺性、詢問病史及職業史、血中鉛的監測、相關實驗室的檢查，以及危險值通報，從而作出正確的診斷。我們回顧相關的文獻、分析整理鉛中毒明顯的特徵，包括：(1)鉛暴露的職業史，(2)慢性反覆性腹痛，合併腸胃道阻塞樣的症狀，(3)輕微貧血，無論正血球性或小球性貧血，及紅血球中嗜鹼性點之有無，(4)血中鉛大於 80μg/dL，作為臨床腹痛鑑別診斷的幫助。家庭醫學科醫師作為第一線醫師，對於腹痛病患求診時，都應將鉛中毒納入鑑別診斷。

Lead poisoning is a rare but still encountered cause of abdominal pain in general practice in Taiwan. Unfamiliarity with the disease results in mis-or delayed diagnosis, inadequate treatment, and patients' continuous exposure in the work environment. We reported a lead battery worker suffering from recurrent abdominal pain, nausea, anorexia, and body weight loss. Correct diagnosis was achieved by clinical astuteness of a family physician, occupational and medical history taking, blood lead level surveillance, and a laboratory results feedback mechanism. Relevant literature was searched, retrieved, and synopsized to generate a set of most salient characteristics of lead poisoning, which include (1) an occupational history of lead exposure, (2) chronic or recurrent abdominal pain associated with gastrointestinal obstruction-like phenomenon, (3) mild anemia, normo- or microcytic, with or without basophilic stippling of red blood cells, (4) blood lead level higher than 80 μg/dL. The criteria are expected to aid in the differential diagnosis of abdominal pain. As front-line practitioners, family physicians can make great contributions to the discovery of occupational diseases in the future.