scholarly journals Rare cases of severe life-threatening lead poisoning due to accident or chronic occupational exposure to lead and manganese: Diagnosis, treatment, and prognosis

2020 ◽  
Vol 36 (12) ◽  
pp. 951-959
Author(s):  
Xuqin Du ◽  
Wei Zheng ◽  
Qiao Ye
Keyword(s):  
Occupational Exposure ◽  
Chelation Therapy ◽  
Herbal Remedy ◽  
Lead Level ◽  
Clinical Manifestations ◽  
Blood Lead ◽  
Severe Nausea ◽  
Abdominal Colic ◽  
Life Threatening ◽  
General Populations

Background: Chronic long-term, low-dose environmental and occupational exposure to lead (Pb) has been extensively studied in large cohorts worldwide among general populations, miners, smelters, or battery workers. However, studies on severe life-threatening Pb poisoning due to accidental or chronic occupational exposure to Pb and manganese (Mn) were rarely reported. Methods: We present one case of acute severe Pb poisoning and compare it with another severe chronic occupational exposure case involving Pb and Mn. A 27-year-old woman mistakenly took a large quantity of pure Pb powder as an herbal remedy; she developed abdominal colic, severe nausea, vomiting, fatigue, and cutaneous and sclera icterus. Laboratory tests showed her blood lead level (BLL) of 173.5 µg dL−1 and urinary lead level (ULL) of 1240 µg dL−1. The patient was diagnosed with acute Pb poisoning and acute liver failure. In another chronic exposure case, a 56-year-old man worked in a Pb and Mn smelting factory for 15 years. He was brought to the emergency room with severe nausea, vomiting, and paroxysmal abdominal colic, which was intolerable during the onset of pain. His BLL was 64.8 µg dL−1 and ULL was 38 µg dL−1, but his blood and urinary Mn levels were normal. The patient was diagnosed with chronic Pb poisoning. Both patients received chelation therapy with calcium disodium ethylene-diamine-tetraacetate (CaNa2EDTA). The woman with acute severe Pb intoxication recovered well and was discharged from the hospital after treatment, and the man who survived severe Pb poisoning was diagnosed with lung cancer. Conclusion: Clinical manifestations of acute and chronic severe Pb poisoning are different. Chelation therapy with CaNa2EDTA is proven to be an effective life-saving therapy in both cases by reducing BLL. Occupational exposure to both Pb and Mn does not appear to increase Mn neurotoxicity; however, the probability that co-exposure to Mn may increase Pb toxicity in the same patient cannot be excluded.

Clinical manifestations of lead workers of Mangalore, India

2006 ◽  
Vol 22 (9) ◽  
pp. 405-413 ◽  
Author(s):  
Ajee Kuruvilla ◽  
V.V. Pillay ◽  
Prabha Adhikari ◽  
T. Venkatesh ◽  
M. Chakrapani ◽  
...  
Keyword(s):  
Blood Lead Level ◽  
Lead Level ◽  
Clinical Manifestations ◽  
Blood Lead ◽  
Exposed Group ◽  
Blood Lead Levels ◽  
Abdominal Colic ◽  
Significant Difference ◽  
Lead Levels ◽  
Battery Workers

Objective: To correlate blood lead levels and clinical manifestations. Participants: Battery workers and painters (occupationally exposed to lead in and around Mangalore, India) and occupationally unexposed controls. Main outcome measures: We measured the blood lead levels by anodic stripping voltammetry, and a clinical examination was carried out on all participants. Results: There was a statistically significant difference between the lead-exposed group and controls with respect to clinical manifestations. The prominent findings among the lead-exposed group were fatigue, abdominal colic, abdominal discomfort, backache, muscular exhaustability, myalgia and paresthesia, at a blood lead level ranging from 0.4 to 116.6 μg/dL. Conclusions: Such a study on battery workers and painters has not been reported in India. Several attempts have been made over the years to relate blood lead levels to adverse health effects. It was not possible to determine a precise blood lead level below which symptoms never occur or a blood lead level at which symptoms are always reported. Toxicology and Industrial Health 2006; 22: 405-413.

scholarly journals Acute lead poisoning: a diagnostic challenge in the emergency department

2021 ◽  
Vol 14 (1) ◽  
pp. e239740
Author(s):  
Bharath Gopinath ◽  
Vignan Kappagantu ◽  
Roshan Mathew ◽  
Nayer Jamshed
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Chelation Therapy ◽  
Acute Abdominal Pain ◽  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Diagnostic Challenge ◽  
Common Presentation ◽  
Life Threatening

Acute abdominal pain is a common presentation to the emergency department (ED). Ruling out life-threatening causes and giving pain relief are the most important tasks in ED. We describe a 32-year-old man who presented to ED with abdominal pain and vomiting which was unrelieved by usual doses of analgesic. Extensive investigations revealed no significant abnormalities. On further probing, he admitted taking traditional medications for infertility. The toxicological panel revealed a high blood lead level, leading to a diagnosis of acute lead toxicity. Chelation therapy with D-penicillamine was initiated and the patient’s abdominal pain resolved within 4 days.

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

2019 ◽  
Vol 18 (4) ◽  
pp. 529 ◽  
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.

Lead Study Results Questioned

PEDIATRICS ◽  
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.

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

PEDIATRICS ◽  
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.

scholarly journals A CASE REPORT ON CHRONIC LEAD POISONING FROM OCCUPATIONAL EXPOSURE

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.

scholarly journals Lead encephalopathy in adults

2014 ◽  
Vol 5 (02) ◽  
pp. 161-163 ◽  
Author(s):  
Janapareddy Vijaya Bhaskara Rao ◽  
Bhuma Vengamma ◽  
Thota Naveen ◽  
Vandanapu Naveen
Keyword(s):  
Health Hazard ◽  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Lentiform Nucleus ◽  
Abdominal Colic ◽  
Lead Encephalopathy ◽  
Lead Line ◽  
Management Issues

Lead poisoning is a common occupational health hazard in developing countries. We report the varied clinical presentation, diagnostic and management issues in two adult patients with lead encephalopathy. Both patients worked in a battery manufacturing unit. Both patients presented with seizures and one patient also complained of abdominal colic and vomiting. Both were anemic and a lead line was present. Blood lead level in both the patients was greater than 25 μg/dl. Magnetic resonance imaging of brain revealed bilateral symmetric involvement of the thalamus, lentiform nucleus in both patients and also the external capsules, sub-cortical white matter in one patient. All these changes, seen as hyperintensities in T2-weighted images suggested demyelination. They were advised avoidance of further exposure to lead and were treated with anti-epileptics; one patient also received D-penicillamine. They improved well on follow-up. Lead encephalopathy is an uncommon but important manifestation of lead toxicity in adults.

scholarly journals Blood lead level and risk of hypertension in the United States National Health and Nutrition Examination Survey 1999–2016

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Man Fung Tsoi ◽  
Chris Wai Hang Lo ◽  
Tommy Tsang Cheung ◽  
Bernard Man Yung Cheung
Keyword(s):  
Blood Pressure ◽  
Lead Exposure ◽  
Blood Lead Level ◽  
Lead Level ◽  
Blood Lead ◽  
The United States ◽  
Study Data ◽  
Blood Lead Levels ◽  
Environmental Lead ◽  
Lead Levels

AbstractLead is a heavy metal without a biological role. High level of lead exposure is known to be associated with hypertension, but the risk at low levels of exposure is uncertain. In this study, data from US NHANES 1999–2016 were analyzed. Adults with blood lead and blood pressure measurements, or self-reported hypertension diagnosis, were included. If not already diagnosed, hypertension was defined according to the AHA/ACC 2017 hypertension guideline. Results were analyzed using R statistics version 3.5.1 with sample weight adjustment. Logistic regression was used to study the association between blood lead level and hypertension. Odds ratio (OR) and 95% confidence interval (95% CI) were estimated. Altogether, 39,477 participants were included. Every doubling in blood lead level was associated with hypertension (OR [95%CI] 1.45 [1.40–1.50]), which remained significant after adjusting for demographics. Using quartile 1 as reference, higher blood lead levels were associated with increased adjusted odds of hypertension (Quartile 4 vs. Quartile 1: 1.22 [1.09–1.36]; Quartile 3 vs. Quartile 1: 1.15 [1.04–1.28]; Quartile 2 vs. Quartile 1: 1.14 [1.05–1.25]). In conclusion, blood lead level is associated with hypertension in the general population with blood lead levels below 5 µg/dL. Our findings suggest that reducing present levels of environmental lead exposure may bring cardiovascular benefits by reducing blood pressure.

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