Lead Poisoning

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Metal poisoning is a wide area of toxicological sciences. Lead is the most widely used metal after iron. The danger to public health from lead in the environment continues to be a matter of concern, for the effects of the element on central nervous system. Children are more susceptible to lead poisoning than adults.

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Lead Poisoning

  1. 1. Case reports of lead poisoning – Commonly undiagnosed poisoning in Gujarat Arun Kavad and Dr. Aruna Dewan* *Director (MD, Toxicologist), CEARCH Toxicology Services, Ahmedabad, India. CEARCH Toxicology Services web. - www.cearch.in
  2. 2. INTRODUCTION  There are many traditional systems of medicine in the world, each with different associated philosophies and cultural origins.  Now–a–days people give preference to the Ayurvedic medicines as the allopathic medicines are costlier and have side effects.  Lead based paint is the most important source of lead exposure for young children .  This paper will concentrate on the issue of heavy metal poisoning related to ayurvedic traditional medicines and leaded paint. CEARCH Toxicology Services web. - www.cearch.in
  3. 3. Lead Poisoning  Lead poisoning is a medical condition in humans and other vertebrates caused by increased levels of the heavy metal lead in the body.  Lead interferes with a variety of body processes and is toxic to many organs and tissues including the heart, bones, intestines, kidneys, reproductive and nervous systems. Acceptable blood lead levels in USA CEARCH Toxicology Services web. - www.cearch.in 1960 60 µg/dl 1970 40 µg/dl 1975 30 µg/dl 1985 25 µg/dl 1991 10 µg/dl
  4. 4. The sources of lead exposure CEARCH Toxicology Services web. - www.cearch.in
  5. 5. Symptoms of Lead Poisoning Children Adults  Irritability  High blood pressure  Loss of appetite  Declines in mental functioning  Weight loss  Pain, numbness or tingling of the extremities  Sluggishness and fatigue  Muscular weakness  Abdominal pain  Abdominal pain  Vomiting  Mood disorders  Constipation  Memory loss  Learning difficulties  Miscarriage or premature birth in pregnant women  Reduced sperm count, abnormal sperm CEARCH Toxicology Services web. - www.cearch.in
  6. 6. Analysis of Lead  Lead is analysed by mainly AAS(Atomic Absorption Spectrometry) and ASV(Anodic Stripping Voltammetry ). AAS ASV  There are also many other kits and instruments available in the market for the analysis of the lead. Eg. X-ray fluorescence (XRF) , graphite furnace atomic absorption spectroscopy, inductively couple plasma-atomic emission spectroscopy, inductively couple plasma-mass spectroscopy etc. CEARCH Toxicology Services web. - www.cearch.in
  7. 7. Lead analysis in CEARCH  We have a Lead Care-II Analyzer for Blood Lead levels in CEARCH.  Benefits of Lead Care-II Analyzer :  Results available in 30 minutes  Economical  Cross checked with Atomic Absorption spectrometer  CDC and WHO recommended  The detection limit of these instrument is: Low : < 3.3 µg/dL High : 65.0 µg/dL CEARCH Toxicology Services web. - www.cearch.in Lead Care-II Analyzer
  8. 8. CASE-1  A 58 year old man took an Ayurvedic medicine named VASANT KUSUMAKAR RAS (Baidyanath) for 3 years.  After taking this medicine, he had gradual weight loss (approx 15 kg), wrist drop, abdominal pain, constipation, nausea and mild mental impairment.  His blood lead level was done by AAS and it was found to be 80 µg/dL and his Hemoglobin levels dropped to 7 gm/dl. CEARCH Toxicology Services web. - www.cearch.in wrist drop
  9. 9.  He was seen by a Neurologist and the ayurvedic medicine was stopped.  Since the drug of choice for Lead poisoning DMSA (Succimer) is not available in India, he was given D-Penicillamine (Chelating agent).  He improved clinically but his blood lead levels remained on higher side.  He was referred to CEARCH for further treatment.  His wrist drop improved but he continued to have hyperaesthesia in feet.  His BLL was repeated at CEARCH using Lead Care-II Analyzer and it was found to be 47.2µg/dL. CEARCH Toxicology Services web. - www.cearch.in
  10. 10.  On taking a detailed history, it was found that he was taking the drug penicillamine at odd times .  He was again put on D-penicillamine with clear instructions to take the drug at least one hour before meals.  This is important as the chelating agent may bind with food components and that affects pharmacokinetics of the drug.  His next visit is awaited . CEARCH Toxicology Services web. - www.cearch.in
  11. 11. CASE-2  A male child with normal developmental milestones till the age of 1.5 years (Crawling, using both hands and feet)  Then he developed pica habit and he also started eating old wall paint which continued for about 6 months.  The child gradually had anemia, weakness of upper and lower limbs (Shoulder muscle weakness), irritable and learning difficulties.  Father suspected lead poisoning (Father’s qualification : B.Sc. Chemistry) by reading from internet.  The child was investigated. CEARCH Toxicology Services web. - www.cearch.in Saifan (3.5 years)
  12. 12. Following tests were carried out to know the reason of illness CEARCH Toxicology Services web. - www.cearch.in Name Of Test Result Normal Range Thyroid Stimulating Hormone Test 2.71 µlU/ml 0.7-6.4 µlU/ml Para Thyroid Hormone 391 pg/mL 11.1-79.5 pg/mL Serum Alanine Aminotransferase Estimation 28.07 U/L 10-50 U/L Serum Calcium Estimation 9.38 mg/dL 8.8-10.8 mg/dL Serum Ionized Calcium 1.30 mmol/L 1.15-1.32 mmol/L Serum Magnesium Estimation 2.47 mg/dL 1.70-2.30 mg/dL Serum Phosphorous Estimation 4.97 mg/dL 3.4-6.2 mg/dL Serum Uric Acid 3.11 mg/dL 3.4-7.0 mg/dL Vitamin-D 17.0 ng/mL Insufficiency:10-30ng/mL COMPLETE BLOOD COUNT Hemoglobin 10.7 g/dL 11.0-14.0 g/dL Hematrocrit 32.1 % 34-40 % R.B.C. Count 4.46 1012/L 4.0-5.2 1012/L W.B.C. Count 10560/cmm 5000-15000/cmm Platelet Count 539000/cmm 200000-490000/cmm
  13. 13.  Specific reason for the illness could not be diagnosed, thus, lead poisoning was suspected to be the possible reason behind the illness of the child.  BLL of the child done by AAS was found to be 148.0 µg/dL.  Child reported at CEARCH with the above mentioned Blood Lead Level. The child was put on D-penicillamine with full instructions and the treatment was continued for one and a half months.  After treatment, child reported to CEARCH again and his blood was analysed by Lead Care-II Analyzer, obtained Blood Lead Level was < 3.3 µg/dL.  To recheck, the same blood sample of child was analysed by AAS at NIOH, which was 2.23 µg/dL.  Blood Lead levels of the same blood sample found at CEARCH and NIOH tallied with other. CEARCH Toxicology Services web. - www.cearch.in
  14. 14. Discussion  In the present two cases of lead poisoning from different sources are observed.  In the first case lead poisoning by ayurvedic medicines, which are easily available in Gujarat.  When patient was treated it was not effective initially since the patient was not taking D-penicillamine on specific timings with respect to his meals.  This resulted in persisting symptoms of lead poisoning.  Therefore decrease in blood lead level was not significant. CEARCH Toxicology Services web. - www.cearch.in
  15. 15.  On the other hand, in the second case patient ingested paint resulting in lead poisoning.  After proper treatment with specific instructions of timings of meals and doses of D-penicillamine, the patient showed gradual decrease in the blood lead level.  The severity of poisoning was high, thus, improvement in health was time consuming.  Initially, lead poisoning can be hard to detect, even people who seem healthy can have high blood levels of lead.  Signs and symptoms usually don't appear until dangerous amounts have accumulated. CEARCH Toxicology Services web. - www.cearch.in
  16. 16. Conclusion CEARCH Toxicology Services web. - www.cearch.in • Although lead poisoning in ayurvedic medicines is not a new subject, But the present case brings out continued ignorance towards ayurvedic medicines. • Adulteration of heavy metals in ayurvedic medicines must be supervised and its packaging & distribution should be strictly governed by government bodies on a consistent basis. • The case of lead poisoning due to paint ingestion shows the forensic importance of paint production against the prescribed laws. • Apart from this, awareness of lead poisoning in children and its symptoms are of great importance in a country like India.
  17. 17. Acknowledgment  I would like to express my gratitude to all those who gave me the possibility to complete this paper. I am deeply indebted to my director Dr. Aruna Dewan, from CEARCH, for her stimulating suggestions & encouragement.  I am obliged to my seniors Anand lodha, Shweta sharma for the valuable information provided. I am grateful for their cooperation during the period of my assignment.  Lastly I am thankful to Shehzadkhan. I. Makrani for his full support and details provided by him. At last I would like to thank all who have even minutely contributed to my work directly or indirectly. CEARCH Toxicology Services web. - www.cearch.in
  18. 18. CEARCH Toxicology Services web. - www.cearch.in

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