Slow, Natural Reduction in Blood Lead Level After Chelation Therapy for Lead Poisoning in Childhood

To the Editor.— In October 1991, the Centers for Disease Control decreased the blood lead level PbB) from 25 to 10 µg/dL and designated it as abnormal because of "overwhelming and compelling scientific evidence"1 that 10 µg/dL is associated with adverse neurobehavioral development. We have evidence to the contrary, obtained in a long-term follow-up of severely lead-poisoned children whom we treated before 1972 for PbBs between 80 and 470 µg/dL (mean, 150.3 ± 77.1 µg/dL); their mean age was 28 months.

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Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting with Motor Neuropathy and Upper Limb Paresis: A case report

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2018.18.04.017 ◽

2019 ◽

Vol 18 (4) ◽

pp. 529 ◽

Cited By ~ 2

Author(s):

Seyed M. M. Mirzaei ◽

Ayob Akbari ◽

Omid Mehrpour ◽

Nasim Zamani

Keyword(s):

Nervous System ◽

Case Report ◽

Lead Poisoning ◽

Chelation Therapy ◽

Lead Level ◽

Lead Toxicity ◽

Blood Lead ◽

Motor Neuropathy ◽

Upper Limbs ◽

Gastrointestinal Complications

Opium users may present with central or peripheral nervous system-related symptoms, gastrointestinal complications and anaemia; in such cases, lead poisoning should be suspected and chelation therapy initiated as soon as possible. We report a 64-year-old male patient with a 20-year history of opium addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with severe motor neuropathy and paresis in both upper limbs. His primary symptoms were generalised weakness, abdominal and bone pain, constipation and lower limb paraesthesia that had started several months prior. In addition, he reported severe progressive bilateral paresis of the upper limbs of one month’s duration. A diagnosis of lead poisoning was confirmed by a blood lead level of 140 μg/dL. The patient underwent chelation therapy after which he improved significantly. At a one-year follow-up visit, he was neurologically intact and symptom-free.Keywords: Opium Dependence; Lead Poisoning; Lead-Induced Nervous System Diseases; Paresthesia; Case Report; Iran.

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Against lead poisoning: effectiveness of housing first and counselling in the home

European Journal of Public Health ◽

10.1093/eurpub/ckz187.138 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

R Laporte ◽

H Barberin de Barberini ◽

E Jouve ◽

K Hadji ◽

S Gentile

Keyword(s):

Lead Poisoning ◽

Lead Exposure ◽

Blood Lead Level ◽

Lead Level ◽

Blood Lead ◽

Housing First ◽

Blood Lead Levels ◽

Stable Housing ◽

Lead Levels

Abstract Background Removing lead sources is the main measure against child lead poisoning. Medical treatment is ineffective for most mild cases and particularly against long-term complications in neurological development. However, the effectiveness of interventions to eliminate sources of lead exposure has not been fully established, mainly because of the diversity of situations. The objective of this study was to determine the influence of several interventions (housing counselling, rehabilitation and relocation) on blood lead levels in two situations (stable unhealthy housing with old flaked lead paints, slums with family recycling practices by incineration). Methodology A historical cohort of lead poisoning in children has been established in Marseille, France. Medical follow-up followed national guidelines. Environmental interventions followed legal procedures, where available. In slums, counselling was adapted to the exposure. A generalized mixed model was developed to study the kinetics of blood lead levels after the interventions. Results 151 children were included; age = 5.4 (SD = 7.8) years; 85 (56%) lived in stable unhealthy housing, others lived in slums. Medical follow-up included 492 blood lead levels. For children living in stable unhealthy housing, blood lead level decrease was significantly associated with every intervention: housing counselling, rehabilitation and relocation (respectively p < 0.005; p < 0.05 and p < 0.005). For children living in slums, blood lead level decrease was only associated with relocation in a stable housing (p < 0.005). Conclusions Several interventions are effective to decrease blood lead levels in unhealthy housing. In slums, access to a stable housing first is a prerequisite for any intervention against child lead poisoning, even when related to family practices. Key messages In stable unhealthy housing, several interventions against lead exposure can be effective to raise a strategy. But, environmental health and access to housing first needs to be addressed for their implementation.

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Lead Exposure and Intellectual Function: Findings from Primary School Children in Bangladesh

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v11i4.12599 ◽

2012 ◽

Vol 11 (4) ◽

pp. 292-297

Author(s):

Mahbuba Haque ◽

M H Faruquee ◽

Suman Lahiry ◽

Saira Tasmin ◽

Rabeya Yasmin ◽

...

Keyword(s):

Primary School ◽

Lead Poisoning ◽

School Children ◽

Blood Lead Level ◽

Lead Level ◽

Medical Science ◽

Blood Lead ◽

Primary School Children ◽

Background Information ◽

The Impact

Backgrounds: About 120 million people around the world are overexposed to lead which is neurotoxic and 99 percent of the most severely affected children are in the developing world including Bangladesh. Methods and Materials: The present cross-sectional ecological study was carried out to explore the impact of lead poisoning on the intelligence level among 84 primary school children of a school of Bangladesh, aged between 8 and 14 years from September 2010 through January 2011. The research instrument was an interviewer questionnaire, questionnaire for IQ test and assessment of blood lead level (inductively-coupled plasma mass spectrometry with collision/reaction cells) of the study subjects after obtaining permission from their parents and the school authority. Results: Data were cross-checked and frequency distribution and association using chi-square test was accomplished. Background information depicted majority (69.1%) of the children aged10-11 years (mean = 10.25 ±1.177 yrs), female (51.2%), parents having primary level of education or below (73.8% in case of father and 77.4% in mother) and from lower socioeconomics (78.6% earned BDT 10,000 or below per month). Among all, majority (56%) were found to be moron, 27.4% in borderline, while 8.3% were imbecile with the same proportion with normal level. By their blood lead level. Majority (70.2%) had blood lead level up to 10 microgram/dl and the rest (29.8%) had more than 10 microgram/dl. Though no statistically significant association was found between IQ level of the children and their blood lead level (p>0.05), the health problems found among the respondents as abdominal pain (53.57%), impatience (14.29%), nausea (10.71%) and all other problems (loss of concentration to study, ear problem, anorexia and loss of weight) amounting for 21.43% are suggestive of chronic lead poisoning. Conclusion:Further studies in large scale with larger samples including comparative studies of inter-industrial areas have been strongly recommended. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12599 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12

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Lead Study Results Questioned

PEDIATRICS ◽

10.1542/peds.69.2.248 ◽

1982 ◽

Vol 69 (2) ◽

pp. 248-248

Author(s):

Philip J. Landrigan

Keyword(s):

Lead Poisoning ◽

Blood Lead Level ◽

Lead Level ◽

Clinical Manifestations ◽

Blood Lead ◽

Study Results ◽

Lead Study

Ernhart et al1 have reported the results of developmental follow-up evaluation of black urban schoolchildren with increased exposure to lead. Perino and Ernhart2 had assessed the development of this same group of children five years previously. In the earlier evaluation, Perino and Ernhart divided the children into low lead (blood lead level, 10 to 30 µg/100 ml) and moderate lead (40 to 70 µg/100 ml) exposure groups; no child in either group had clinical manifestations of lead poisoning.

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Lead Poisoning: From Screening to Primary Prevention

PEDIATRICS ◽

10.1542/peds.92.1.176 ◽

1993 ◽

Vol 92 (1) ◽

pp. 176-183

Author(s):

Keyword(s):

Young Children ◽

American Academy ◽

Lead Poisoning ◽

Blood Lead Level ◽

Lead Level ◽

Blood Lead ◽

Impaired Hearing ◽

American Academy Of Pediatrics ◽

Lead Levels ◽

Us Children

Knowledge of the extent and seriousness of childhood lead poisoning has vastly expanded since the last statement regarding lead poisoning by the American Academy of Pediatrics in 1987.1 Blood lead levels once thought to be safe have been shown to be associated with IQ deficits, behavior disorders, slowed growth, and impaired hearing.2 In fact, lead poisoning is, according to the Department of Health and Human Services, "the most important environmental health problem for young children."3 The rapid development of the scientific database requires recognition by physicians of the significance of effects at lower levels and a change in clinical practice. During the last 30 years the Centers for Disease Control and Prevention (CDC) has revised downward the definition of the blood level at which lead poisoning occurs from 60 µg/dL whole blood in the early 1960s, to 30 µg/dL in 1975, and 25 µg/dL in 1985. The 1991 CDC statement "Preventing Lead Poisoning in Young Children" recommended lowering the community intervention level to 10 µg/dL and setting several action levels (Table 1).2 In 1987 the American Academy of Pediatrics stated that lead levels greater than 25 µg/dL were unacceptable for children.1 The Academy now recognizes that impairment of cognitive function begins to occur at levels greater than 10 µg/dL, even though clinical symptoms are not seen. In the late 1970s, the average blood lead level for US children was 16 µg/dL.4 The mean blood lead level for US children has declined since 1976 due to the phaseout of lead in gasoline5 and the reduction of lead in food, and it is now between 4 and 6 µg/dL.6

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Association of Blood Lead Level with Neurological Features in 972 Children Affected by an Acute Severe Lead Poisoning Outbreak in Zamfara State, Northern Nigeria

PLoS ONE ◽

10.1371/journal.pone.0093716 ◽

2014 ◽

Vol 9 (4) ◽

pp. e93716 ◽

Cited By ~ 22

Author(s):

Jane Greig ◽

Natalie Thurtle ◽

Lauren Cooney ◽

Cono Ariti ◽

Abdulkadir Ola Ahmed ◽

...

Keyword(s):

Lead Poisoning ◽

Blood Lead Level ◽

Lead Level ◽

Blood Lead ◽

Northern Nigeria ◽

Neurological Features

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Effects of Calcium Disodium Versenate (CaNa2EDTA) Chelation in Moderate Childhood Lead Posioning

PEDIATRICS ◽

10.1542/peds.92.2.265 ◽

1993 ◽

Vol 92 (2) ◽

pp. 265-271

Author(s):

Morri E. Markowitz ◽

Polly E. Bijur ◽

Holly Ruff ◽

John F. Rosen

Keyword(s):

Lead Poisoning ◽

Chelation Therapy ◽

Controlled Trial ◽

Lead Level ◽

Chelating Agent ◽

Blood Lead ◽

Erythrocyte Protoporphyrin ◽

Bone Lead ◽

Sustained Reduction ◽

The Relationship

Background. For children with asymptomatic moderate lead poisoning (Blood lead level [BPb] 25 to 55 µg/dL [1.21 to 2.66 µmol/L]), treatment with the chelating agent calcium disodium versenate (CaNa2EDTA) is recommended for all those children with a BPb level >45 µg/dL (2.17 µmol/L) and for those with a BPb level of 25 to 44 µg/dL (1.21 to 2.13 µmol/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 Lα-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 µg/dL (0.23 µmol/L), 41 corrected net counts, and 24 µg/dL (0.46 µmol/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.

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A CASE REPORT ON CHRONIC LEAD POISONING FROM OCCUPATIONAL EXPOSURE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i6.18061 ◽

2017 ◽

Vol 10 (6) ◽

pp. 1

Author(s):

Dhivya K ◽

Nazma M ◽

Divya Sree P ◽

Lakshmi Prasanna S

Keyword(s):

Lead Poisoning ◽

Chelation Therapy ◽

Lead Level ◽

Age Groups ◽

Blood Lead ◽

Toxic Heavy Metals ◽

The World ◽

Education And Awareness ◽

Lead Hazards ◽

Upper Abdomen

The hazard to public health from lead continues to be a matter of concern. It is one of the most serious environmental poisons among the toxic heavy metals all over the world. Lead poisoning is seen in all age groups, especially in adults working in lead-based industries. We report the case of a 28-year-old man working in an unorganized lead-based manufacturing unit admitted with the complaints of giddiness, excessive tiredness, pain in the upper abdomen, decreased appetite, excessive body pains, increased sweating, and oliguria. Investigations carried out during the admission showed hemoglobin levels of 8.5 g/dl and blood lead level (BLL) of 115 μg/dl. The patient was subjected to chelation therapy. After repeated course of chelation therapy, he has shown the signs of improvement. The paucity of a safe workplace and awareness among workers results in high BLLs. Therefore, education and awareness related to lead hazards is considered necessary.

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Using the current Brazilian value for the biological exposure limit applied to blood lead level as a lead poisoning diagnostic criterion

Cadernos de Saúde Pública ◽

10.1590/s0102-311x1996000100013 ◽

1996 ◽

Vol 12 (1) ◽

pp. 31-35 ◽

Cited By ~ 1

Author(s):

Ricardo Cordeiro

Keyword(s):

Lead Poisoning ◽

Blood Lead Level ◽

Lead Level ◽

Blood Lead ◽

Blood Lead Levels ◽

High Relative Risk ◽

Exposure Limits ◽

Exposure Limit ◽

Lead Levels ◽

Diagnostic Criterion

In general, biological exposure limits are only used for the promotion and preservation of workers' health and are not applied for diagnostic purposes. However, the issue is controversial for certain types of occupational poisoning. This paper proposes the utilization of biological exposure limits currently applied to blood lead levels in Brazil as an important criterion for diagnosing occupational lead poisoning. The author argues that contrary to the traditional clinical criterion, one should deal with the diagnostic problem of lead poisoning from an epidemiological perspective, using the current Brazilian value for the biological exposure limit applied to blood lead level as an indicator of high relative risk.

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