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Diagnosis of Plumbism

Ralph D. Caldroney, MD
JAMA. 1982;248(2):172. doi:10.1001/jama.1982.03330020018015.
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To the Editor.—  The recent article by Bird et al in The Journal (1982; 247;813) was a vivid example of the surreptitious manner in which lead intoxication can present itself. This case also points out the difficulty in diagnosing lead intoxication unless sensitive and specific tests are used.The "best" test for the diagnosis of lead storage disease has been a subject of considerable debate.1,2 Most of the currently available tests are centered around lead's interference with heme synthesis or they directly assay lead levels in serum or urine.3 As described in this case, those tests based on measuring alterations in heme synthesis, though sensitive, are far from being specific.While one would assume that direct assays of lead levels would solve the problem of lack of specificity, this is not the case. The problem revolves around the manner in which lead is stored in the body, especially


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