G. Gorun, I. Pârlică, F. Perde, A. Georgescu, G. Gemai
Abstract: Heavy metal poisonings (commonly used terminology) in medicine are becoming increasingly rare due to control and regulation measures regarding their use, as well as limited accessibility to toxins and escalating environmental protection acts. However, with the development of medical detection equipment for toxicological assessments, that is easily accessible to the population and relatively inexpensive, a medico-legal casuistry for investigation in this field has been generated. Amplified by induced copycat phenomena (promoted by vulgar media coverages), this poses major issues to the Romanian system, where technological gaps (regarding the necessary and sufficient equipment, of a completely different standard compared to that used in screening medicine), as well as the absence of overspecialization, had led to disruptions and deviations from the expected probative value allocated to such expertise.
This paper aims to demonstrate, first and foremost, the mandatory distinction between routine testing methods in clinical practice and those required by the medico-legal standard (starting from the very samples, sampling techniques, and laboratory methods), as well as the need for a more in-depth and multiparametric interpretation of the results of certain investigations. This includes breaking the customary significance of threshold values, simplistically and exclusively allocated, that are ignoring, for example, the characteristics of the globalized industrial society and those of current urban life, as well as specific toxicokinetics.
We present a series of cases that have led to the request for medico-legal evaluation, in which initial clues based on the clinical picture and laboratory results, seemingly sustainable within the limits of knowledge of the general population, judicial authorities, and even among medical personnel pertaining to the subject, supported the hypothesis of acute or chronic heavy metal poisoning (frequently of social induction - inception origin).
The illustrative case study in this paper covers both medico-legal autopsy activity and clinical activity (cases involving suspicion of mercury, aluminium, chromium, lead poisoning) by emphasizing data with toxicological relevance, including terminology (through the unifying correlation of clinical and laboratory data with investigative data), principles and procedures that need to be applied in such cases, potential sources of errors (highlighting the tendency of naive/interested patients to resort to pseudoscientific impostors), as well as the specific algorithms of medico-legal reasoning to provide a solid support for conclusions. Keywords: heavy metals, sampling, exposure, biological monitoring, biological effects, reference values.
 in medicine are becoming increasingly rare due to control and regulation measures regarding their use, as well as limited accessibility to toxins and escalating environmental protection acts. However, with the development of medical detection equipment for toxicological assessments, that is easily accessible to the population and relatively inexpensive, a medico-legal casuistry for investigation in this field has been generated. Amplified by induced copycat phenomena (promoted by vulgar media coverages), this poses major issues to the Romanian system, where technological gaps (regarding the necessary and sufficient equipment, of a completely different standard compared to that used in screening medicine), as well as the absence of overspecialization, had led to disruptions and deviations from the expected probative value allocated to such expertise.
<br /> This paper aims to demonstrate, first and foremost, the mandatory distinction between routine testing methods in clinical practice and those required by the medico-legal standard (starting from the very samples, sampling techniques, and laboratory methods), as well as the need for a more in-depth and multiparametric interpretation of the results of certain investigations. This includes breaking the customary significance of threshold values, simplistically and exclusively allocated, that are ignoring, for example, the characteristics of the globalized industrial society and those of current urban life, as well as specific toxicokinetics.
<br /> We present a series of cases that have led to the request for medico-legal evaluation, in which initial clues based on the clinical picture and laboratory results, seemingly sustainable within the limits of knowledge of the general population, judicial authorities, and even among medical personnel pertaining to the subject, supported the hypothesis of acute or chronic heavy metal poisoning (frequently of social induction - inception origin).
<br /> The illustrative case study in this paper covers both medico-legal autopsy activity and clinical activity (cases involving suspicion of mercury, aluminium, chromium, lead poisoning) by emphasizing data with toxicological relevance, including terminology (through the unifying correlation of clinical and laboratory data with investigative data), principles and procedures that need to be applied in such cases, potential sources of errors (highlighting the tendency of naive/interested patients to resort to pseudoscientific impostors), as well as the specific algorithms of medico-legal reasoning to provide a solid support for conclusions.&redirect_uri=http://rjlm.ro/index.php/arhiv/1035)