Occupational lead poisoning due to deficient protective measures at the work place

History and admission findings: A 27-year-old man who was working in the mixing plant of a company manufacturing sythetic materials, was admitted with colicky upper abdominal pain, loss of appetite and postprandial nausea for 3 weeks. On examination he had pain without guarding over the abdomen. Investigations: He had a normochronic anaemia (haemoglobin 12.5. g/dl). Ultrasound of the abdomen revealed splenomegaly. Gastroscopy excluded an ulcer. Deep duodenal biopsy showed Giardia intestinalis histologically. Diagnosis, treatment and course: As part of the differential diagnosis of abdominal colic and anaemia, lead posoning was found, with the lead level markedly elevated to 1776 mug/l. Penicillamine treatment rapidly reduced the blood lead level, but it had not yet become normal after 4 months. Exposure to lead at his work place was discovered. Subsequent tests there by the federal agency for occupational protection revealed massive deficiencies in protective measures. Conclusion: In present conditions abdominal colic must be viewed as a cardinal symptom of lead poisoning. Blood levels must be obtained as part of the differential diagnosis of abdominal pain of uncertain aetiology. If the diagnosis has been established and an occupational risk is possible, the appropriate occupational organizations and, if necessary, federal agency must be informed in order to exclude occupational exposure to lead. In Germany there still exist marked deficiencies in the protection of workers occupationally exposed to lead. Notification is essential to protect others similarly at risk.