ZDRAVSTVENI UČINCI METALA

1. ZDRAVSTVENI UČINCI METALA

2. TEŠKI METALI IMAJU • IZRAZITI AFINITET PREMA KISIKU I SUMPORU • NA OVOJ SPOZNAJI POČIVA TOKSIKOLOGIJA TEŠKIH METALA

4. OTROVANJE OLOVOMSATURNIZAM

5. Toksični teški metal • kontaminant radnog i globalnog okoliša, posebice urbanih centara

6. Procjenjuje se da je opterećenje organizma naših suvremenika i do 1000x veće nego u naših predaka, • iako ekspolatacija olovne rudače datira iz davne prošlosti ljudskog roda

7. OLOVNI SJAJNIK ILI GALENIT (PbS) • najčešća, ali toksikološki neinteresantna olovna rudača, obzirom da je Pb već vezan za S, pa je taj spoj NEOTROVAN

8. OLOVNI KARBONAT ILI CERUSIT (PbCO3) • OTROVAN, • jer se u organizmu ion olova odvaja iz spoja i traži S

10. In general, the older your home, the more likely it has lead-based paint. *  • Paint.  Many homes built before 1978 have lead-based paint.  The federal government banned lead-based paint from housing in 1978.  :  • In homes in the city, country, or suburbs.  • Inside and outside of the house.  • In soil around a home. • Household dust. (Dust can pick up lead from deteriorating lead-based paint or from soil tracked into a home.) • Drinking water. Your home might have plumbing with lead or lead solder. You cannot see, smell, or taste lead, and boiling your water will not get rid of lead.

11. The job. If you work with lead, you could bring it home on your hands or clothes. Old painted toys and furniture.  • Food and liquids stored in lead crystal or lead-glazed pottery or porcelain.  • Lead smelters or other industries that release lead into the air.  • Hobbies that use lead, such as making pottery or stained glass, or refinishing furniture.  • Folk remedies that contain lead, used to treat an upset stomach.

12. Otrovni su OLOVNA PARA, DIM I PRAH • Putevi unosa: •  inhalacija ! (najvažniji put unosa u profesionalnoj toksikologiji) •  ingestija ! (put unosa važan u vicinalnoj toksikologiji) •  perkutano (unos zanemariv s oba aspekta)

13. Inhalacija • najopasniji put unosa  Pb ulazi direktno • u krv  • 95 % ioniziranog Pb se veže na E te s tu prisutnim fosfatima stvara primarne, sekundarne i tercijarne spojeve, a 5% ostaje u plazmi i širi se po cijelom organizmu

14. Najvažniji toksični učinak :POREMEĆAJ SINTEZE HEMOGLOBINA.

15. Slide 14 of 41 Notes: The mitochondria of the developing red cell are responsible for the synthesis of protoporphyrin which then combines with iron to form heme. This is a stepwise process which begins with the formation of delta aminolevulinic acid from glycine and succinyl COA. The phosphorylated form of pyridoxine, pyridoxal-5-phosphate, is an essential cofactor in this reaction. The subsequent sequence of porphobilinogen, uroporphyrin, and coproporphyrin formation occurs in the cytoplasm, after which there is an intramitochondrial assembly of protoporphyrin and iron to form heme. A schematic of the final product, a protoporphyrin ring structure with its central iron molecule is shown.

17. Laboratorijska dg. saturnizma • 1. određivanje plumbemije • The standard elevated blood lead level (BLL) for adults' is (25 µg/dl) This level recognizes that every adult has accumulated some lead contamination. • The level for a child is much lower, currently it is (10 µg/dl) • a worker's blood lead level (BLL, be maintained at or below forty (40 µg/dl)

18. 2.NESPECIFIČNI TESTOVI, ALI OD VELIKOG PRAKTIČNOG ZNAČAJA • =određivanjed-DALK-a; ZPP, EPP (eritrocitni protoporfirin), FPP (slobodni protoporfirin) • Normalna aktivnost ako je d-DALK 15mol/L i više • Normala za EP 2,67 mol/L

19. 3.POTPUNO NESPECIFIČNI SCREENING-TESTOVI • E, retikulociti, Fe, bazofilni punktati

20. Ingestija • posuđe s olovnom glazurom u kom je kiseli sadržaj (vino, ukiseljeno povrće i sl.)  kiselina otopi olovnu glazuru i nastaje olovna sol odnosne organske kiseline (tartarat, citrat, acetat)  kod konzumenta se razvija slika trovanja

22. Klinička slika saturnizma: • 1. Gastrointestinalni oblik • 2. Neuromuskularni oblik • 3. Encefalopatički oblik • 4. Mješoviti oblik

27. Najjopasniji organski spoj olova  • tetraetil-olovo = lakohlapljiva tekućina, nakon inhalacije olovna encefalopatija, moguć letalni ishod

28.  Djeca su posebno osjetljiva na olovo • U novorođenčadi i male djece apsorpcija Pb iz GI trakta je značajno veća nego u odraslih, tako da raste važnost peroralnog puta unosa

29. FETOTOKSIČNOST Pb • Dobro prolazi transplacentarnu barijeru, • a prisutan je i u majčinom mlijeku

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31. BLLs of workers (both male and female workers) who intend to have children should be maintained below 30 µg/dl to minimize lead poisoning of the parents and their future children.

32. Teratogeni učinci • spontani pobačaji, • prijevremeni porođaji, • kongenitalne anomalije

33. Do druge godine života djeca profesionalno izloženih roditelja pokazuju na testovima inteligencije izrazito slabije rezultate od svojih vršnjaka, • ali se kasnije te razlike gube

34. Th. saturnizma • kelatni spojevi • najčešće CaNa2EDTA

36. OTROVANJE ŽIVOM  MERKURIJALIZAM

37. What are sources of exposure to elemental mercury? • Sources of elemental mercury include broken mercury thermometers, broken fluorescent light bulbs, dental amalgam fillings, mercury containing latex paints, extraction of gold from ore using mercury, and contaminated clothing from workers in thermometer making plants. Elemental mercury is also used as a Mexican folk medicine to treat "empacho," a chronic stomach disorder.

38. S toksikološkog aspekta treba razlikovati: • 1. elementarnu Hg (ne može stvarati kemijske veze!!) • 2. anorganske Hg-spojeve (toksičnost se osniva na stvaranju merkuri-iona) • 3. organske Hg-spojeve (toksičnost potenciraju alkilni radikali)

39. "You wouldn’t take a leaky thermometer, put it in your mouth, and leave it there 24 hours a day, 365 days a year. Yet that’s exactly what happens when an amalgam filling is installed in your mouth."----Dr Michael Ziff.

40. Toxicity of ThimerosalAn Organic Mercurial Added To Vaccines • Is this any place to put a toxic organic mercury compound?

41. Paul J. Dunn, MD, • "On average, Chicago rainwater had mercury levels 12 times higher than that human standard." • Amalgam is 50% mercury. With chewing, mercury vapor is released and readily absorbed.

42. Paul J. Dunn, MD, • Incidentally, anyone who still has amalgam fillings in their mouth should not use the supplement lipoic acid because it mobilizes mercury into other parts of the body. • In my own practice I have had several patients who had no amalgam fillings in their mouth but their hair mineral analyses showed high levels of mercury. . . . In each instance, fish had been frequently consumed over a long period.

43. Putevi unosa: •  inhalacija Hg para i prašine (NAJVAŽNIJI PUT UNOSA U PROFESIONALNOJ TOKSIKOLOGIJI !) •  perkutano (metil-Hg spojevi i kroz intaktnu!!!) •  ingestija (predominantno konzumacija ribe) •  transplacentarno (organski Hg spojevi)

44. A)PROFESIONALNA TROVANJA ANORGANSKIM HG-SPOJEVIMA • 2 kardinalna sindroma: • 1. orofaringealni sy (hipersalivacija, gingivitis, ispadanje zubi) • 2. neuropsihički u 3 moguća oblika: •  asteničko-vegetativni oblik ili “mikromerkurijalizam”(nespecifični simptomi) •  živin tremor •  živin eretizam

45. Pulmonalne toksične manifestacije: • ·akutna intersticijska pneumonija, • bronhitis, • bronhiolitis

46. Nefrotoksične manifestacije: • proteinurija, • nefrotski sindrom

47. B) TROVANJA ORGANSKIM HG-SPOJEVIMA • organski spojevi žive uspijevaju svojim manjim dijelom prijeći cerebralnu barijeru, ali se potom jednoliko raspoređuju i akumuliraju u mozgu  loša prognoza

49. Koža • fenilni i metoksi-etilni spojevi!) • dermatitis, u fulminantnim oblicima sa nekrotičnim lezijama

50. Bubreg, orofarinks- kao kod anorganske Hg • respiratorni trakt - iritacija dišnih puteva, toksični edem pluća