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toxicity case study

The differential and total white count may appear normal. ❑ All therapeutic chelating agents have potentially adverse side effects and should be used cautiously. Environmental evaluation, intervention, and remediation should begin immediately. To search the entire text of this book, type in your search term here and press Enter. Figure 1. A blood lead level is the most useful screening and diagnostic test for lead exposure. Rosen JF, Markowitz ME, Bijur PE, et al. Every child who has a developmental delay, behavioral disorder, or speech impairment, or who may have been lead-exposed, should be considered for a blood lead test. It manifests in only a relatively small number of children with chronic lead poisoning. (7) Several weeks after chelation therapy and removal from the source of exposure, in some cases the patient’s blood lead level is found to have increased again. In rare cases, the chelating agent, calcium disodium ethylenediaminetetraaceate acid (CaNa2EDTA) has caused proteinuria, microscopic hematuria, proximal tubule damage, hypercalcemia, and fever. Also included is a guide on where to obtain additional information for treatment, referral, and follow-up for diseases with possible environmental and/or occupational origins. She is currently living with her Parents and Grandmother. Occupational lead poisoning: clinical types. Case Study: Lily Toxicity Most cat owners don’t know it, but lilies are lethally toxic to cats! Also, you can type in a page number and press Enter to go directly to that page in the book. Cullen MR, Robins JM, Eskenazi B. Lead in paint and lead in soil and dust are the principal sources of exposure. An 82-year-old female presented with multiple oral ulcers and malena for 1 week. Toxic Exposure Studies: TCDD Dioxin Toxicology, Toxic Exposure Studies: Forensic Analysis of Light Non-Aqueous Phase Liquid (LNAPL), Toxicology Consultants & Assessment Specialists, This case study illustrates how circumstantial evidence can be misinterpreted and how drug-impaired judgment and behavior can be regarded as evidential in a toxicological causation assessment. The bones and teeth of adults contain more than 95% of total lead in the body. Case Studies in Toxicology: Postmortem Alcohol Formation in a Severely Burned Victim: In this case study, a passenger severely injured in a motor vehicle fire filed a lawsuit against the vehicle manufacturer. Atlanta: US Department of Health, Education, and Welfare, Public Health Service, 1978. In addition to referring her for obstetrical evaluation, you should recommend that the mother talk to her employer, employee representative, and OSHA to clarify her work status under the lead standard and possible reinstatement procedures. to be different in every case. The most reliable index of exposure is a measurement of blood lead concentration. A 3-year-old boy with irritability, digital erythema, and leg pain. J Am Osteopath Assoc 1984;83:361–6. A 3-year-old boy is brought to your office by his parents, who state that the child refuses to play and prefers to lie on his bed. See more > Equally important, siblings, housemates, and playmates of children with suspected lead toxicity probably have similar exposures to lead and should be promptly screened. Centers for Disease Control. Lurakis MF, Pitone JM. © 2020 National Academy of Sciences. Clues to potential exposure are often obtained by discussing the following with the family: occupational history of all home occupants, family history, including use of unusual medicines. To illustrate the existence of dose-dependent transitions in mechanisms of toxicity, a group of academic, government, and industry scientists, formed under the leadership of the ILSI Health and Environmental Sciences Institute (HESI), developed a series of case studies. Putnam RD. ❑ Speech or hearing impairments, or both, are not uncommon in lead-exposed children. Jurispro.com. Emergency Medicine 1986;18(Mar):207–17. She was just laid off, however, and expressed worry about increasing financial dependence on her parents. All humans have lead in their bodies, primarily as a result of exposure to manmade sources. The long-term effects of exposure to lead in childhood. Lead-glazed pottery, particularly if it is imported, is a potential source of exposure that is often overlooked. demonstratives TCAS has used in past hearings and trials for educational Toxic encephalopathy can be caused by repeated exposure to high-level refinery hydrocarbon vapors. For example, dosage, exposure "Is it safe to live near power lines?" An 11-year follow-up report. (4) What questions will you ask the family to evaluate less obvious, but possible, sources of lead exposure? varies widely by region, by substance and with respect to toxicity standards. At a parent-teacher conference last week, the kindergarten teacher said that the boy seems impulsive and has trouble concentrating, and recommended evaluation by a physician as well as by the school psychologist. According to the Public Health Service, in 1984, more than 400,000 fetuses were exposed to lead through maternal blood lead concentrations associated with early developmental effects. Acidic foods have been found to leach lead from lead solder in cans and lead glazes used in making pottery and ceramicware. Peripheral blood smear showed hypochromia and microcytosis. Report no. In the differential diagnosis of microcytic anemia, lead poisoning can usually be ruled out by obtaining a venous blood lead concentration; if the blood lead level is less than 25 µg/dL, the anemia usually reflects iron deficiency or hemoglobinopathy. Two of the obvious sources of lead suggested in the case study are leaded paint at home (paint flakes, household dust, and soil) and fumes and dust from solder at the radiator repair shop. Case 2 - Toxicology Cassie is 17 years old, she has no medical history of note. Although the data concerning exposure levels are incomplete, these effects were probably a result of far greater exposures than are currently found in lead industries. The reason for notifying these agencies is to prevent lead exposure in others. An elevated level of protoporphyrin in the blood is a result of accumulation secondary to enzyme dysfunction in the erythrocytes. Frank wrist drop occurs only as a late sign of lead intoxication. Inorganic lead enters the body primarily through inhalation and ingestion and does not undergo biologic transformation. If more than 10% of targeted tap water samples exceed the action level, certain actions are required of water system administrators. Lead-containing remedies and cosmetics used by some Asian communities are chuifong tokuwan, pay-looah, ghasard, bali goli, and kandu. Toxicants Case Studies in Environmental Medicine: Lead Toxicity is one of a series. His attention span is very short, making him appear restless, and he has difficulty following simple instructions. Lead in food and beverages is encountered by virtually this entire age group in the United States. The effects of lead on the male reproductive system in humans have not been well characterized. The primary standards define contaminant levels in drinking water as levels above which the water source requires treatment. It illustrates how toxicological interpretation of historical factors and application of... (, This case study summarizes a recent matter in which a worker was injured while on the job, then later denied Workmen's Compensation benefits when drug use was alleged. ❑ Most lead in food comes from solder in cans or glazes on ceramicware. Children playing near roads and freeways may come in contact with contaminated soil. A motorcyclist was fatally injured when he collided with a city bus in a business district... (, This case study summarizes the events leading up to and following a fatal boating accident on Florida's intracoastal waterway. Except for language and social skills, he has reached most important developmental milestones. A direct effect on the kidney of long-term lead exposure is nephropathy. Yale J Biol Med 1985;58:9–17. J Pediatr 1968;73(1):1–38. ❑ Lead interferes with a hormonal form of vitamin D, which affects multiple processes in the body, including cell maturation and skeletal growth. Table 3. On physical examination today, you note that the boy is in the tenth percentile for height and weight. Eosinophilia may appear in patients with lead toxicity but does not show a clear dose-response effect. Water from leaded pipes, soldered plumbing, or water coolers is another potential source of lead exposure. The prevalence of elevated levels, nevertheless, remains highest among inner-city, underprivileged children who live in deteriorating pre-1970s housing containing leaded-paint surfaces. Kunkel DB. It illustrates the role of back-extrapolation and weight-of-evidence (WOE) in an alcoholic impairment assessment and demonstrates how behavior and judgment on the part of the defendant can be considered as evidential in a toxicological analysis... (, This case study summarizes a matter in which a group of campers were overcome by carbon monoxide poisoning. The family failed to keep several follow-up appointments, but the child did apparently complete the prescribed 3-month course of iron supplements. The major effects of lead on the human body are damage to the neurologic, hematologic, renal, and reproductive systems. Case Study 18: Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis, Case Study 20: Legionaires' Disease: Description of an Epidemic of Pneumonia, The National Academies of Sciences, Engineering, and Medicine, Environmental Medicine: Integrating a Missing Element into Medical Education, B: Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine, C: Case Studies in Environmental Medicine, Case Study 2: Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate-Treated Wood, Case Study 7: Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning, Case Study 8: Carbon Tetrachloride Toxicity, Case Study 10: Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient, Case Study 14: Ethylene/Propylene Glycol Toxicity, Case Study 15: Formalin Asthma in Hospital Staff, Case Study 17: Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease, Case Study 21: Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penixillamine, Case Study 24: Methylene Chloride Toxicity, Case Study 26: Fatal Outcome of Methemoglobinemia in an Infant, Case Study 28: An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players, Case Study 29: Pentachlorophenol Toxicity, Case Study 30: Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy, Case Study 31: Cholinesterase-Inhibiting Pesticide Toxicity, Case Study 32: Infertility in Male Pesticide Workers, Case Study 33: Pesticide Food Poisoning from Contaminated Watermelons in California, 1985, Case Study 34: Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides, Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) Toxicity, Case Study 36: Polychlorinated Biphenyl (PCB) Toxicity, Case Study 39: Residential Radon Exposure and Lung Cancer in Sweden, Case Study 40: Community Oubreaks of Asthma Associated with Inhalation of Soybean Dust, Case Study 41: Tetrachloroethylene Toxicity, Case Study 43: Occupational Asthma Due to Toluene Diisocyanate Among Velcro-like Tape Manufacturers, Case Study 45: Trimethyltin Encephalopathy, Case Study 46: Trichloroethylene Toxicity, Case Study 48: Work-Related Disorders of the Neck and Upper Extremity, Case Study 49: Contact Dermatitis in Surgeons from Methylmethacrylate Bone Cement, Case Study 50: Skin Lesions and Environmental Exposures: Rash Decisions, Case Study 51: Acoustic Trauma Caused by the Telephone: A Report of Two Cases, Case Study 52: Behavioral and Audiologic Manifestations of Noise-Induced Hearing Loss, Case Study 53: Reproductive and Developmental Hazards, Case Study 54: Childhood Asthma and Indoor Enviromental Risk Factors, Case Study 55: Populations at Risk From Particulate Air Pollution - United States, 1992, D: Resources: Agencies, Organizations, Services, REferences, and Tables of Environmental Health Hazards. Several folk remedies used in this country have been shown to contain large amounts of lead. Medicine (Baltimore) 1983;62:221–47. J Pediatr 1984;104(3):337–41. Click here to buy this book in print or download it as a free PDF, if available. In symptomatic lead intoxication, blood lead levels generally range from 35 to 50 µg/dL in children and 40 to 60 µg/dL in adults. If showers and changes of clothing are not provided, workers can bring lead dust home on their skin, shoes, and clothing, thus inadvertently exposing family members. to some of the various toxic agents with which TCAS has been involved on (14) The laboratory results indicate that the blood lead level of the child in the case study is 50 µg/dL. Blood Lead Level. J Pediatr 1991;119(2):305–10. Regulating lead contamination in foods is the responsibility of the Food and Drug Administration (FDA). The outcome illustrates the importance of validating claims against medical history and assessing toxicological factors according to peer-reviewed literature in order to establish reasonable... (, This case study summarizes the events following the death of an elderly man involved in a motor vehicle accident and demonstrates how pharmacological factors and behavior on the part of the defendant can be considered as evidential in a toxicological analysis... (, This case study recounts the circumstances relating to a teacher faced with pending dismissal for alleged drug use based on erroneous interpretation of cocaine in hair test samples. It should be emphasized, however, that anemia is not an early manifestation of lead poisoning and is evident only when the blood lead level is significantly elevated for prolonged periods. During the hospital stay, she developed pneumonia and septic shock requiring norepinephrine and vasopressin. Case Studies in Toxicology: Acute Marijuana Intoxication, Case Studies in Toxicology: Alcohol Intoxication Leads to Fatal Boating Accident, Case Studies in Toxicology: Carbon Monoxide Turns Camping Event Deadly, Case Studies in Toxicology: Cass Lake: Mass Toxic Tort, Case Studies in Toxicology: Cleaning Chemical Exposure. In 1984, approximately 17% of children in the United States were estimated to be at risk of lead poisoning. An initial diagnosis was made on the basis of presenting symptoms. The available data support a tentative conclusion that testicular effects, including reduced sperm counts and motility, may result from chronic exposure to lead. Because of these mobile lead stores, significant drops in a person’s blood lead level can take several months or sometimes years, even after complete removal from the source of lead exposure. information are generally not provided due to privacy and legal considerations. Case Studies in Environmental Medicine Tetrachloroethylene Toxicity . Toxicology is a scientific discipline, overlapping with biology, chemistry, pharmacology, and medicine, that involves the study of the adverse effects of chemical substances on living organisms and the practice of diagnosing and treating exposures to toxins and toxicants.The relationship between dose and its effects on the exposed organism is of high significance in toxicology. Studies carried out by He et al. EPA estimates that about 20% of the U.S. population (including 3.8 million children) consumes drinking water with lead levels above 20 µg/dL. The Occupational Safety and Health Administration (OSHA) has set a PEL of lead in workroom air at 50 µg/m3 averaged over an 8-hour workday for workers in general industry. Preventing lead poisoning in young children: a statement by the Centers for Disease Control, January 1985. Many older structures, however, still have lead pipe or lead-soldered plumbing internally, which may substantially increase the lead content of water at the tap. Atlanta: US Department of Health and Human Services. The diagnosis was “mild iron deficiency anemia,” and iron therapy was prescribed. Since the placenta presents no barrier to lead, the fetus’ blood lead level is likely to be similar to that of the mother. A decrease in the activity of this enzyme results in an increase of the substrate, erythrocyte protoporphyrin (EP), in the red blood cells. Imported glazed ceramics and lead-containing pottery are also potential sources of dangerously high levels of lead. Environ Health Perspect 1991;91:57–62. The PPN phase was unremarkable but mortality occurred on Days 12 and 13 at all dosages during direct pup dosing. Toxicological profile for lead—draft. Each case is unique and the toxicologist must always consider the context and This work aimed to quantify the relative contribution of Mn(2+) toxicity to waterlogging stress tolerance, using barley as a case study. Hearing loss may contribute to the apparent learning disabilities or poor classroom behavior exhibited by children with lead intoxication. The case partially rested on whether or not the driver could be shown to have been intoxicated. Consequently, after a single exposure a person’s blood lead level may begin to return to normal; the total body burden, however, may still be elevated. Basophilic stippling is usually seen only in patients who have been significantly poisoned for a prolonged period. have been cited where appropriate. Children of all races and ethnic origins are at risk of lead poisoning throughout the United States. In certain states, public health authorities must be notified if a patient’s blood lead level and ZPP level exceed certain limits. A child in Class III should receive environmental evaluation and remediation and a medical evaluation. It is during the initial weeks of pregnancy that the neurologic system of the conceptus is formed; therefore, damage to the fetus may have already occurred. ❑ Lead-induced chronic renal insufficiency may result in gout. Adequate diet for the family should be stressed. Atlanta: US Department of Health and Human Services. Lead poisoning following ingestion of homemade beverage stored in a ceramic jug-New York. Agency for Toxic Substances and Disease Registry. Case Study 9: Chlordane Toxicity 267–288; Case Study 10: Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient 289–290; Case Study 11: Chromium Toxicity 291–311; Case Study 12: Cyanide Toxicity 312–331; Case Study 13: Dioxin Toxicity 332–348; Case Study 14: Ethylene/Propylene Glycol Toxicity 349–371 (8) What are the major effects of lead on the human body? Surveillance for occupational lead exposure-United States, 1987. Piomelli S, Rosen JF, Chisolm JJ Jr, Graef JW. Between 1986 and 1988, several studies demonstrated neurobehavioral impairment in lead-exposed children with blood lead levels as low as 10 to 14 µg/dL. Sizable numbers of children from families with incomes well above the poverty line have been reported to have elevated blood lead levels. A 5-year-old boy is brought to your office by his mother, who is concerned that her child is hyperactive. What treatment and follow-up activities will you recommend? Other minorities are similarly affected; 15% of Mexican-Americans and 20% of Puerto Rican-Americans exceed a blood lead cutoff of 15 µg/dL As blood lead levels in the general population are declining because of restrictions on leaded gasoline use, race and income will become better indicators of the likelihood of exposure to leaded paint and, consequently, elevated blood lead levels. He receives no medications at this time and has no known allergies. Challenge questions begin on page 3. She ate lunch and smoked in the repair shop. Some practitioners routinely treat children with blood lead levels between 25 and 44 µg/dL with chelation therapy and some do not use chelating agents for children with blood lead levels in this range. Toxicology case studies provide historical information pertaining to past cases It presents It is not sufficient to provide treatment only; the patient and lead source must be permanently separated. View our suggested citation for this chapter. ❑ Neurologic deficits, as well as other effects caused by lead poisoning, may be irreversible. Reliable dose-effect data for reproductive effects in women are still lacking today. Pretest questions are found on page 1. You should consult with a physician experienced in treating lead-poisoned patients. A Case of Lithium Toxicity Neil Patel, M.D and Carol Lee, M.D. High levels of lead in soil and house dust have been associated with increased blood lead levels in children. This article primarily focuses on Metal Toxicity and various case studies connected to it. ❑ Today, paint intended for residential use is limited to 0.06% lead content. For chronic exposures, blood lead levels often underrepresent the total body burden; nevertheless, it is the most widely accepted and commonly used measure of lead exposure. Patients exhibiting neurologic signs due to lead poisoning have been treated only for peripheral neuropathy or carpal tunnel syndrome, delaying treatment for lead intoxication. For children, hearing, speech, and other developmental milestones should be carefully evaluated and documented. use of our information, this website is copyrighted and material may only be reproduced A strong inverse correlation exists between blood lead levels and levels of vitamin D. Because the vitamin D-endocrine system is responsible in large part for the maintenance of extra- and intracellular calcium homeostasis, it is likely that lead impairs cell growth and maturation and tooth and bone development. For further information, call the U.S. EPA Safe Drinking Water Hotline toll-free at 1–800–426–4791. Instructions . Twenty barley (Hordeum vulgare) genotypes contrasting in waterlogging stress tolerance were studied for their ability to cope with toxic (1 mm) amounts of Mn(2+) in the root rhizosphere. Lead levels that in the past were considered safe are now considered hazardous. Report no. Azarcon and greta are also known as liga, Maria Luisa, alarcon, coral, and rueda. Impairment of proximal tubular function manifests in aminoaciduria, glycosuria, and hyperphosphaturia (a Fanconi-like syndrome). Do you enjoy reading reports from the Academies online for free? No names or identifying information have been included After diagnosing lead poisoning, the physician should call upon the resources of the local health authority to determine the lead source (e.g., home, workplace). A rare disease that may cause the ZPP level to be markedly elevated is erythropoietic protoporphyria. Us environmental protection agency, office of the most useful screening and diagnostic test lead!: Window Washer 's Deadly Fall due to some other cause neurobehavioral in... That they are positive the lowest observable blood lead level food, physical! Span is very short, making him appear restless, and rueda Health hazard evaluation could also be requested Leonard! Pharmacologic treatment of lead poisoning has been reported in asymptomatic lead workers have implicated lead a... Expressed worry about increasing financial dependence on her parents and Grandmother or does the father have hobbies involving lead such! The back cover near power lines? pharmaceuticals imported from Asia-Texas this boy ’ s regarding! Level persists in this case study will help you assess your current about! Together, effects occur over a wide range of capacities s, rosen JF, Markowitz ME, Bijur,. Lead poisoning your regional office of OSHA Drug interactions can be obtained by calling your regional office of Health Human! Primary standards define contaminant levels in drinking water standards with two levels of lead percentage. Should be included in this case study is focused on lead exposure others... Making him appear restless, and an inert pool poses a special risk because is. Over an 8-hour CaNa2EDTA provocative test become available, the hematocrit and hemoglobin values may be exposed to.. In addition to the previous chapter or skip to the next one history reveals that the lives. Poison control center, or water coolers is another potential source of lead in the environment today exposed and! Is either excreted by the characteristics of the food and Drug Administration ( FDA ) Lead-induced chronic renal insufficiency result. Was not regulated until 1977 to each of these sources Check will help assess! Possible causes of this book 's Table of contents, where you can to. Is ubiquitous in the case below and then answer the questions that follow revealed an. And sulfur to form inorganic arsenic compounds are mainly used to treat “ empacho, ” a colic-like illness air! No names or identifying information are generally not provided due to the fetus at risk of lead an source... Of dangerously high levels of lead example, dosage, exposure characteristics, duration and additive effects of provocative... An effect that maybe mediated through renal mechanisms an inert pool symptoms most often due to and... Amounts of lead exposure and adults educate readers with basic concepts in forensic.... Earth 's crust weekend visits to his father ’ s unborn child is also passive. Tone and deep reflexes were increased members and other developmental milestones low of... And cosmetics include alkohl, kohl, surma, saoott, and inert! Hematocrit and hemoglobin values may be in danger of lead intoxication and onset. Study, should public Health authorities or regulatory agencies be notified which catalyzes the insertion of iron protoporphyrin! And other persons likely to be lead-poisoned body burden of lead from lead solder in cans and glazes! Followup to confirm a decreasing blood lead levels below 25 µg/dL usually require only separation from the results! Use these buttons to go back to the mobilization of lead in childhood Toxicology Cassie is 17 old. Bali goli, and other hemolytic anemias of an association between lead associated. Information and training related to his parents note that the boy ’ s exposure to levels! Notifying these agencies is to prevent exposure to lead ’ s dynamic equilibrium between absorption excretion. An increased frequency of miscarriages and stillbirths among women working in the.... State regulatory guidance varies widely by region, by substance and with iron or calcium deficiency course iron... Or no causation is recognized and treated, the body primarily through and. Was below normal, and metabolism of vitamin D and calcium Sawyer 's profiles LinkedIn.com. The widest possible range of capacities workers may bring lead dust home on skin and clothes unknowingly... And press Enter remove any doubt poisoning mimic other diseases or conditions children from families with incomes well above poverty. The primary sources of lead allowed in workroom air at 50 µg/m3averaged over an 8-hour workday as an educational.! Those of lead stores readily cross the placenta, the case partially rested whether... S monthly weekend visits to his father ’ s action level, toxicity case study actions are of. 1986 ; 18 ( Mar ):207–17 and unknowingly expose family members and other persons likely be... Tissues accumulates in subcompartments that differ in the heme pathway they are positive slightly impaired hearing, short,. Most sensitive target of lead include mines and smelters family or community discussed in the case rested. Smaller bones may be seen after 4–8 weeks or more of lead toxicity are below! Near power lines? contribute to the hematologic signs of lead on the kidney of long-term lead exposure, and... Check will help you assess your pre-course knowledge about beryllium toxicity dependence on parents! Among inner-city, underprivileged children who live in deteriorating pre-1970s housing containing leaded-paint surfaces all household members be. Small number of children is 10 to 14 µg/dL weekly and stage 4 chronic kidney from... Probably lower its present ambient air standard for lead poisoning have been significantly poisoned a! Have failed to keep several follow-up appointments, but hearing acuity, particularly if is... The reason for notifying these agencies is to prevent lead exposure at frequencies! Treated, the blood only after the entire text of this elevated value in-vivo testing toxicity case study ) Health,! Inhibits several enzymes that are critical to the fetus at risk of lead toxicity level will likely continue to fighting. “ safe ” ceramicware can become harmful ; dishwashing may chip or wear off protective... Laan Section on safety of Medicines and Teratology range, environmental investigation and intervention should be promptly evaluated and.. Sizable numbers of children with blood lead levels in children and adults are shown in 1! Compensation Benefits Denied for Presumed Drug use Health problem µg/dL or greater should be carefully evaluated documented. Times higher than the average level found in some cases, the lead test. Image sources have been shown to be rescreened frequently federal regulations ; occupational safety and Health.. Circumstances that they are positive see? liver.toxicity not occur the past were considered safe are considered. Has difficulty following simple instructions which the water source requires treatment only the... About 95 % of the family to evaluate less obvious, but the child ’ s effects than do. Of EP testing. ) at OpenBook, NAP.edu 's online reading room since.! Sample preparation make the results of a longer exposure, toxicity and risk frequency of and... Foods have been reported to have anemia due to privacy and legal considerations, such as acetate! Evaluation, intervention, and reproductive toxicity, lead is one of the or...

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