Saturnine Gout is due to(2018)

Chronic lead Poisoning (plumbism; saturnism): Chronic poisoning results from a daily intake of one to two mg of lead. Signs and Symptoms : (1) Facial Pallor : The facial pallor paicularly about the mouth is one of the earliest and most consistent sign. It seems to be due to vasospasm. (2) Anaemia : There may be polycythaemia with polychromatophilia in early stages, but later there is anaemia which is associated with polychromasia, punctate basophilia, reticulocytosis, poikilocytosis, anisocytosis, nucleated red cells (sideroblasts) and an increase in mononuclear cells, whereas polymorphonuclear cells and platelets are decreased. The anaemia is due to inhibition of haeme synthesis by interference with the incorporation of iron into protoporphyrin. 3 )Leadline : A stippled blue line, called Buonian line, is seen on the gums in 50 to 70% of cases. It appears due to subepithelial deposit of granules at the junction with teeth, only near diy or carious teeth, within a week of exposure, especially on upper jaw. It is due to formation of lead sulphide by the action of hydrogen sulphide formed by decomposed food in the mouth. 4) Colic and Constipation : (5) Lead Palsy: There may be tremors, numbness, hyperaesthesia, and cramps before the actual muscle weakness. It is commoner in adults than in children, and men are paicularly affected. The muscle groups affected are those most prone to fatigue. Usually the extensor muscles of the wrist (wrist drop; radial nerve is affected) are affected, but the deltoid, biceps, anterior tibial (foot drop), and rarely muscles of eye or intrinsic muscles of hand or foot are affected. The paralysis is associated with degeneration of the nerve and atrophy of the muscles. Recovery may be complete but is usually slow. ( 6) Encephalopathy :*Lead encephalopathy, in some form is said to be present in almost every case of plumbism. It is common in children often associated with tetraethyl lead. The symptoms are vomiting, headache, insomnia, visual disturbances, irritability, restlessness, delirium, hallucinations, convulsions, coma and death. Lead encephalopathy is usually irreversible and about 85% have permanent brain damage. Death occurs in about 25% cases. (7) Cardiovascular System and Kidneys : Lead causes vascular constriction, leading to hypeension and permanent aeriolar degeneration. Chronic aeriosclerotic nephritis and interstitial nephritis occur. (8) Reproductive System : Menstrual derangements, such as amenorrhoea, dysmenorrhoea, menorrhagia, sterility of both sexes, and aboion are frequent. Aboion occurs in pregnant women between 3 to 6 months. (9) Other Systems : They are dyspepsia, anorexia, emaciation, general weakness, exhaustion, irritability, foul breath, headache, veigo, loss of hair and drowsiness. Peripheral neuritis is rare. Retinal stippling is noticed by ophthalmoscopic examination showing presence of greyish glistening lead paicles in the early phase of poisoning. Ref:- k.s.narayan reddy; pg num:- 544