Exposure to tetraethyl lead (TEL), found in leaded gasoline, can occur with gasoline sniffing or in the occupational setting. TEL is metabolized to inorganic lead and triethyl lead. Triethyl lead is the primary toxic product that produces predominantly CNS toxicity. Symptoms range from behavioral changes with irritability, insomnia, restlessness, and nausea and vomiting to tremor, chorea, convulsions, and mania. Muscle, hepatic, and renal damage can occur. Anemia and elevated erythrocyte protoporphyrin levels are usually not found. PbB levels may be normal or elevated. Therapy consists of removal from the source, symptomatic treatment, and chelation only if the PbB level is elevated. Sequelae include dementia, mental status alterations, and persistent organic psychosis.
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