Lead poisoning diagnostic study of choice: Difference between revisions

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{{Lead poisoning}}
{{Lead poisoning}}
{{CMG}}; {{AE}}{{AKS}}
{{CMG}}; {{AE}}{{AKS}}
== Overview ==
== Overview ==
The best and the most accurate method to diagnose [[lead poisoning]] is directly measuring the venous blood lead levels.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
* The following result of [gold standard test] is confirmatory of [disease name]:
* [{Blood Lead Levels] is the gold standard test for the diagnosis of [[lead poisoning]]. <ref name="pmid22468050">{{cite journal| author=D'souza HS, Dsouza SA, Menezes G, Venkatesh T| title=Diagnosis, evaluation, and treatment of lead poisoning in general population. | journal=Indian J Clin Biochem | year= 2011 | volume= 26 | issue= 2 | pages= 197-201 | pmid=22468050 | doi=10.1007/s12291-011-0122-6 | pmc=3107416 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22468050  }} </ref>
** Result 1
* The following result of [[blood lead levels] is confirmatory of [[lead poisoning]]:
** Result 2
** BLL >5mcg/dL <ref name="pmid17718907">{{cite journal| author=Herman DS, Geraldine M, Venkatesh T| title=Evaluation, diagnosis, and treatment of lead poisoning in a patient with occupational lead exposure: a case presentation. | journal=J Occup Med Toxicol | year= 2007 | volume= 2 | issue=  | pages= 7 | pmid=17718907 | doi=10.1186/1745-6673-2-7 | pmc=2000868 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17718907  }} </ref>
* The [name of the investigation] should be performed when:
 
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison of various diagnostic studies for [disease name] ====
==== The comparison of various diagnostic studies for [disease name] ====
Line 31: Line 24:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
! style="background: #696969; color: #FFFFFF; text-align: center;" |Blood Lead Levels
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
|}
<small> ✔= The best test based on the feature </small>
<small> Blood Lead Levels= The best test based on the feature </small>


===== Diagnostic results =====
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
The following result of direct venous blood lead levels in patients is confirmatory of [[lead poisoning]]:
* Result 1
* BLL >5mcg/dL
* Result 2
* BLL >40mcg/dL requires treatment with chelating agents


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
 
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
The BLL test should be performed when:
* A positive [test] is detected in the patient, to confirm the diagnosis.
* The patient presented with symptoms like abdominal pain ("lead colic"), joint/muscle aches, short-term memory problems, difficulty concentrating, irritability, anemia and nephropathy is the first step of diagnosis.
* A positive venous blood lead levels >5mcg is detected in the patient, to confirm the diagnosis.
The rest of the main laboratory tests that measure lead effects are:
*[[free erythrocyte protoporphyrin test]]
*[[zinc protoporphyrin test]]
*[[CBC]] with blood smear morphology
*[[blood urea nitrogen]]
*[[serum creatinine]]
*[[urinalysis]]


=== Diagnostic Criteria ===
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3


IF there are clear, established diagnostic criteria:
*There are no established criteria for the diagnosis of [[lead poisoning]]. What matters in diagnosing [[lead poisoning]] is directly measuring the blood lead levels in venous blood.
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].




Revision as of 16:10, 15 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D.

Overview

The best and the most accurate method to diagnose lead poisoning is directly measuring the venous blood lead levels.


Diagnostic Study of Choice

Study of choice

  • [{Blood Lead Levels] is the gold standard test for the diagnosis of lead poisoning. [1]
  • The following result of [[blood lead levels] is confirmatory of lead poisoning:
    • BLL >5mcg/dL [2]


The comparison of various diagnostic studies for [disease name]

Test Sensitivity Specificity
Blood Lead Levels 100% 100%

Blood Lead Levels= The best test based on the feature

Diagnostic results

The following result of direct venous blood lead levels in patients is confirmatory of lead poisoning:

  • BLL >5mcg/dL
  • BLL >40mcg/dL requires treatment with chelating agents
Sequence of Diagnostic Studies

The BLL test should be performed when:

  • The patient presented with symptoms like abdominal pain ("lead colic"), joint/muscle aches, short-term memory problems, difficulty concentrating, irritability, anemia and nephropathy is the first step of diagnosis.
  • A positive venous blood lead levels >5mcg is detected in the patient, to confirm the diagnosis.

The rest of the main laboratory tests that measure lead effects are:

Diagnostic Criteria

  • There are no established criteria for the diagnosis of lead poisoning. What matters in diagnosing lead poisoning is directly measuring the blood lead levels in venous blood.


References

  1. ↑ D'souza HS, Dsouza SA, Menezes G, Venkatesh T (2011). "Diagnosis, evaluation, and treatment of lead poisoning in general population". Indian J Clin Biochem. 26 (2): 197–201. doi:10.1007/s12291-011-0122-6. PMC 3107416. PMID 22468050.
  2. ↑ Herman DS, Geraldine M, Venkatesh T (2007). "Evaluation, diagnosis, and treatment of lead poisoning in a patient with occupational lead exposure: a case presentation". J Occup Med Toxicol. 2: 7. doi:10.1186/1745-6673-2-7. PMC 2000868. PMID 17718907.

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