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PubMed2001

[Anemia secondary to lead poisoning. Our experience with 12 cases].

BACKGROUND: A decrease in hemoglobin production is probably the main cause of anemia observed in patients poisoned by lead although hemolysis caused by the effects on membrane or by inhibition of other enzymes such as 5'-pyrimidine nucleotidase may also play a key role. The main lead exposure source comes from lead use in industry; however, outside occupational exposure, food and water consumption is the main cause of lead exposure. MATERIALS AND METHODS: Clinical and analytical characteristics are reported of twelve patients with lead poisoning of food and water source occurred in the last 14 years in two health areas in north Extremadura. RESULTS: The exposure source was wine, vinegar and olives in one case, hand-made brandy in five, water consumption in houses with lead piping, and in two cases the cause was not determined. The clinical picture was similar in all cases with the exception of one female patient who had encephalopathy and hepatic failure. Diagnosis was suggested by regenerative anemia with basophilic stippling of erythrocytes. All patients received oral calcium disodium EDTA. CONCLUSIONS: Lead poisoning in non-industrial areas is a rare entity. Nevertheless, owing to the use of artisanal procedures for wine elaboration and derivatives, its occurrence is increasing. In a patient with symptoms of lead poisoning and regenerative anemia, a peripheral blood smear should be reviewed.

Aged↗
PubMedDate not supplied

[Lead poisoning from traditional Indian medicines].

BACKGROUND: The use of traditional remedies is spreading rapidly in developed countries. Although it is commonly thought that such medications are not harmful because they are of natural origin, they often contain dangerous ingredients, especially heavy metals. Several cases of poisoning, mainly lead poisoning, have been published, but none to our knowledge in France. We recently observed a case of lead poisoning in a man who had been taking ayurvedic remedies. CASE: A 32-year-old man was repeatedly hospitalized for paroxysmal abdominal pain with constipation, weight loss, anemia, and mild elevation of liver enzyme levels. Four months after the initial admission, blood lead measurement showed heavy metal poisoning. The patient was treated with a chelating agent and recovered uneventfully. Investigation revealed that the lead source was self-medication with an ayurvedic remedy, a powder used for four weeks before the first hospitalization. DISCUSSION: To our knowledge this is the first reported French case of lead poisoning due to a traditional remedy. The problem is undoubtedly more widespread, however, for use of traditional remedies is growing more here, and many of them contain dangerous ingredients. Patients from communities known to use traditional medicines or recently returned from countries where such treatments are widespread should be directly questioned about their use of these remedies, because this information will not usually be volunteered. Information directed at populations at risk is also advisable, for most users are unaware that so-called 'natural' medicines can be dangerous.

Abdominal Pain↗
PubMed1987

Lead poisoning in cattle.

Lead poisoning is a frequent cause of poisoning in domestic animals. Signs of encephalopathy and gastroenteritis are commonly observed in cattle following lead poisoning. This article discusses the etiology, epidemiology, pathogenesis, clinical signs, diagnosis, postmortem findings, and treatment of lead poisoning in cattle.

Animals↗
PubMed2003

A global approach to childhood lead poisoning prevention.

Childhood lead poisoning is an important, preventable environmental disease affecting millions of children around the world. The effects of lead are well known and range from delayed and adversely affected neurodevelopment to severe health outcomes including seizures, coma, and death. This article reviews the childhood effects of lead poisoning, the approach being taken to the problem in the United States, and the obstacles faced by developing nations in dealing with lead exposure. The United States has attacked the childhood lead poisoning problem by attempting to eliminate sources of exposure, including gasoline, solder in water pipes and cans, and industrial emissions. These actions have resulted in a dramatic reduction in the number of children with elevated blood lead levels in the United States over the last two decades. However, many developing countries are just beginning to address the problem. Successful efforts will need to incorporate epidemiologic methods, source identification, enforced regulations, and a long-term government commitment to eliminating lead as a threat to the next generation of children.

Child, Preschool↗
PubMed1993

Lead poisoning.

While lead is a very old poison whose toxicity was known to the ancient Greeks, new information about mechanisms and effects of lead toxicity is continually being discovered. Family practitioners should be alert to the possibility of lead poisoning and the situations in which it occurs. Symptoms may be non specific and careful questioning of patients or their parents may be required to identify possible exposure.

Absorption↗
PubMed1995

[Screening for lead poisoning in children by measuring lead levels in housing: a study of the Paris region].

Screening programs for lead poisoning in France rely usually on the preliminary identification of risk factors among children seen in Maternal and Child Health (MCH) clinics. To assess the potential relevance of screening strategies based on the quantification of exposure to lead in housing, we estimated first the prevalence of exposure to lead in a representative sample of older buildings, then the prevalence of lead poisoning among children living in those buildings where high levels of lead had been found. Exposure to lead was measured in dust and paint samples collected in hallways and other collective areas of the buildings. Venous blood samples were collected from the children aged 10 months to 6 years residing in buildings where lead exceeded 1.5 g/kg in paint samples or 1000 micrograms/m2 in dust samples. Paint and dust samples were collected in 137 buildings: 74% presented high dust and/or paint lead contents. Blood samples were collected from 145 out of a total of 189 children residing in these buildings: blood lead levels (PbB) were higher than or equal to 10 micrograms/dl for 65% of these children; 29% were higher than or equal to 15 micrograms/dl, 16% higher than or equal to 20 micrograms/dl. Out of 42 children with PbB > or = 15 micrograms/dl, 21 had not been previously identified through the screening program conducted in local MCH clinics. Clinic-based and environment-based screening appeared to be complementary. It seems thus justified to develop screening strategies based on the assessment of exposure to lead in the environment.

Child↗
PubMed1995

[Studies on biological indicator values in diagnosis for lead poisoning].

Blood lead levels, urine lead levels, indicators of porphyrin metabolism and other biological indicators were determined in 330 workers exposed to lead and 100 unexposed controls with national standardized methods for quality assurance. Data were analyzed with modern statistical methods in a microcomputer with SAS software. Criteria values for blood lead and urine lead were formulated with curve fitting and discriminant analysis, and local normal upper limit values were 1.43 and 0.25 mumol/L for blood lead and urine lead, respectively, acceptable upper limit values 1.93 and 0.35 mumol/L, respectively, and diagnostic values for poisoning 3.02 and 0.56 mumol/L, respectively. Correlation between workplace air lead concentrations and biological indicators, between blood lead levels and other indicators, and their specificity, sensitivity, accuracy and underdiagnosis and misdiagnosis were evaluated at the same time to provide a reference database for revising the national diagnostic criteria for lead poisoning.

Adult↗
PubMed2004

A randomized trial of calcium supplementation for childhood lead poisoning.

OBJECTIVE: Lead (Pb) poisoning remains a common disease among children despite successful public health efforts that have reduced its prevalence. Treatment options for children with blood Pb levels (BPbs) <45 micro g/dL are limited because chelation therapy is generally not indicated. Calcium (Ca) and Pb interactions are well documented. Competition for binding to Ca-binding proteins may underlie a mechanism for Pb absorption. The purpose of this study was to determine the role, if any, of supplemental Ca at reducing BPbs in moderately poisoned children. METHODS: Children aged 1 to 6 years with BPbs 10 to 45 micro g/dL were enrolled in a double-blinded, placebo-controlled trial of the effects of Ca supplementation on BPbs. Children received either a Ca-containing liquid or an indistinguishable placebo. Dosage was adjusted biweekly on the basis of responses to a dietary Ca intake questionnaire to reach 1800 mg in the Ca-supplemented group. Samples for BPbs and measures to assess safety were collected before and after 3 months of supplementation and after an additional 3 months of follow-up. Bivariate and multiple regression analyses were performed. RESULTS: A total of 67 of 88 enrolled children with a mean age of 3.6 years completed 3 months of supplementation. There were no statistically significant differences between groups on hematologic and biochemical measures, including serum and urinary Ca, at any time points. The average compliance rate was estimated to be 80% for each group during the 3-month supplementation period. CONCLUSIONS: At enrollment, the average daily Ca intake in this group of inner-city children was greater than the recommended daily intake for age. Although BPbs declined during a 3-month period in both groups, Ca supplementation aimed at providing 1800 mg of Ca/day had no effect on the change in BPbs. Ca supplementation should not be routinely prescribed for mild to moderately Pb-poisoned children who are dietarily Ca sufficient.

Calcium↗
PubMed2005

Exhumation examination to confirm suspicion of fatal lead poisoning.

Acute poisonings with inorganic lead compounds are exceptionally rare. In all cases of diagnosis, there are two possible sources of error: failing to recognise lead poisoning when it is present, and mistaking other diseases for lead poisoning. If exposure history is carefully taken and proper laboratory techniques are employed, the diagnosis of lead poisoning should not be difficult. In the described case of the death of a 41-year-old-man, no enzymatic disturbances characteristic of congenital erythropoietic porphyria were ascertained, and furthermore, a considerable concentration of lead was found in antemortem material, 5 months before death (blood: 1584 microg/l, urine: 531 microg/24 h). Postmortem tissue lead content in the biological material, exhumed 6 months after death, were as follows: liver, 47.6 microg/g; kidney, 4.75 microg/g; bone, 103 microg/g of sacral vertebra, 20.4 microg/g of femoral bone, 112 microg/g of pelvis; hair, 30.2 microg/g of scalp hair, 33.7 microg/g of pubic hair; nails, 13.6 microg/g. The results indicated a case of acute lead poisoning (with lead(II) oxide, as it later turned out), which manifested as acute intermittent porphyria.

Adult↗
PubMed2002

[Lead poisoning--a case report].

Lead poisoning may cause irreversible health defects, including anaemia, central nervous system problems and various organ defects. We describe a patient with lead poisoning. A 54-year-old woman was admitted to hospital with anaemia and unspecific gastrointestinal symptoms. Peripheral blood smear and bone marrow aspirate showed basophilic stippling of erythrocytes suggestive of lead poisoning, which was confirmed by high concentrations of lead in her blood. The lead source was the glazing of a ceramic wine jug. Chelating therapy was started. Haemoglobin was normalised; the patient returned to work after nine months. Correct diagnosis and treatment can prevent serious health problems caused by lead poisoning.

Bone Marrow Examination↗
PubMed2005

Improving strategies to prevent childhood lead poisoning using local data.

Lead poisoning remains an important, yet entirely preventable, disease among children worldwide. Children's blood lead levels (BLLs) have been declining in the United States; however, nearly half a million children have BLLs > or = 10 microg/ dl, the level targeted for elimination by 2010. Attainment of this national goal will require translating knowledge into public health practice. The Centers for Disease Control and Prevention (CDC) funds state and local health departments to develop comprehensive prevention programs and surveillance. The Jefferson County, Kentucky Program, which includes Louisville, adopted CDC's recommendation for targeting lead testing to children at highest risk and used knowledge of risk factors for lead poisoning to develop prevention strategies. Blood lead testing was targeted to Louisville neighborhoods at high risk, i.e., those characterized by housing built before 1950 and valued < $50,000, which are known risk factors for BLLs > or = 10 microg/dl among children. We evaluated the impact of these and other interventions. Testing of children aged 9-24 months who were born in high risk housing increased from 64.5% to 73.7% (p-value <0.001) among the 1996 and 2000 birth cohorts. Among the 1996 and 2000 birth cohorts, there was no significant change in testing of children born in low risk housing, i.e., built after 1950 and valued at > or = $50,000 (37.0-37.5%; p-value = 0.649). This report demonstrates that applying scientific knowledge to public health practice and using surveillance and other data to evaluate practice effectively increased testing of children at high risk for lead poisoning, increased lead-safe housing, and empowered communities to protect their children from lead exposure.

Cohort Studies↗
PubMed1993

Effects of calcium disodium versenate (CaNa2EDTA) chelation in moderate childhood lead poisoning.

BACKGROUND: For children with asymptomatic moderate lead poisoning (Blood lead level [BPb] 25 to 55 micrograms/dL [1.21 to 2.66 mumol/L]), treatment with the chelating agent calcium disodium versenate (CaNa2EDTA) is recommended for all those children with a BPb level > 45 micrograms/dL (2.17 mumol/L) and for those with a BPb level of 25 to 44 micrograms/dL (1.21 to 2.13 mumol/L) who also have a positive lead mobilization test. However, controlled studies demonstrating its efficacy at inducing a sustained reduction in BPb level or lead-related toxicity have not been performed in children with moderate lead poisoning. This study assesses the relationship between CaNa2EDTA chelation and measures of lead burden and toxicity in children with moderate lead poisoning. METHODS: Two hundred one children with moderate lead poisoning were enrolled. Sequential changes in BPb concentrations, bone lead level as measured by L alpha-x-ray fluorescence, and lead-induced toxicity as assessed by erythrocyte protoporphyrin levels were determined over a 7-week period. From this group, children with a positive lead mobilization test received CaNa2EDTA chelation therapy. RESULTS: Children with positive lead mobilization tests had on average higher initial BPb, bone lead, and erythrocyte protoporphyrin concentrations. The chelated children decreased approximately 4.7 micrograms/dL (0.23 mumol/L), 41 corrected net counts, and 24 micrograms/dL (0.46 mumol/L) more than the unchelated children on BPb, bone lead, and erythrocyte protoporphyrin values, respectively. However, children with higher initial levels decreased the most, whereas children with lower initial levels showed the least decline, with or without treatment. When the initial values on the measures were controlled analytically, or when subgroups matched on initial levels were compared, there were no significant differences between the chelated and unchelated children. CONCLUSIONS: The apparent effectiveness of CaNa2EDTA at reducing lead burden and toxicity is no longer observed when the pretreatment levels are considered. The findings suggest that sufficient doubt about CaNa2EDTA efficacy now exists to warrant a randomized controlled trial of chelation therapy in moderately lead-poisoned children. However, until such studies are performed, it would be premature to withhold chelation treatment on the basis of this study alone.

Bone and Bones↗