Lead poisoning Quiz: Ace Your Exams
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A 52-year-old man comes to the primary care PA complaining of excessive fatigue and weakness for the last several weeks. During this period, he has also been experiencing cramping abdominal pain and increasing constipation. Past medical history is significant for hypothyroidism, which is well-controlled with levothyroxine. He has been working at a battery manufacturing plant for the past 20 years. Temperature is 37.0°C (98.6°F), pulse is 88/min, respirations are 13/min, and blood pressure is 124/88 mmHg. Physical examination shows conjunctival pallor. The neck is nontender, and no mass is palpated. Oropharyngeal examination reveals gingival pigmentation. There is bilateral weakness when extending the wrists against resistance. Laboratory investigations show the following:
Which of the following is the most likely diagnosis?
| Laboratory Value | Result | Reference Range |
| Sodium | 132 mEq/L | 136-146 mEq/L |
| Potassium | 4.2 mEq/L | 3.5-5 mEq/L |
| Chloride | 95 mEq/L | 92-98 mEq/L |
| BUN/Cr | > 20:1 | 10:20:1 |
| TSH | 1.9 μU/mL | 0.5-5 μU/mL |
| Hemoglobin | 9.7 g/dL | 13.5-17.5 g/dL |
| Mean corpuscular volume | 74 fL | 80-100 fL |
| Ferritin | 152 ng/mL | 15-200 ng/mL |
Which of the following is the most likely diagnosis?
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