Cases Of Lead Poisoning Research Articles

OCCUPATIONAL AND ENVIRONMENTAL LEAD POISIONING : CASE STUDY OF A BATTERY RECYCLING SMELTER IN TAIWAN

The rapid industrialization in Taiwan has caused both prosperity and environmental pollution. The purpose of this study is to demonstrate a case of both occupational and environmental lead poisoning. A patient of lead poisoning initiated a survey of the battery recycling factory, which revealed that 31 of 64 workers suffered from lead poisoning. Children who attended a nearby kindergarten showed a significant increase of blood lead up to 15-25 micrograms/dl and a mild but significant decrease of IQ (intelligent quotient, by Binet-Simon scale) if compared with children of a nonexposed but socioeconomically comparable kindergarten. Outdoor workers of the nearby forging factory also showed a significant increase of blood lead if compared with indoor workers or workers of another nonexposed forging factory 20 Km away. Air sampling showed an average of more than 10 micrograms/m3 in the kindergarten. Soil sampling and analysis also revealed 400 folds increase of lead content, which decreased if the sample was taken deep down to 15-30 cm or 350 meters away from the battery recycling smelter. Moreover, after children were moved away from the pollution source, follow-up examination performed 2.5 years later showed a significant decrease of blood lead and partial recovery of IQ among them.

Avoiding Type II error in assessing lead toxicity plaintiffs

This article discusses statistical parallels between excessive conservatism and insufficient conservatism in rendering forensic opinions. The elements of a tort are reviewed and their relation to psychological and psychiatric opinions is also discussed, as are psychometric and clinical approaches to assessment of impairment and causation in individual lead poisoned children. It is argued that assessments in lead poisoning cases consisting solely of cranial nerve examinations result in considerable Type II Error. Sources of Type II Error in research using analysis of covariance techniques to study the toxic effects of lead include variance stealing, use of excessive numbers of covariates, lack of attention to interactions, and use of covariates that are actually substitute measures of lead ingestion. When experts cite nonsignificant findings of studies of low-level lead exposure, it inappropriately negates lead effects in more severely lead poisoned plaintiffs. In true experimental studies where there is no ambiguity regarding causation, the destructive effects of lead are quite clear. © 1998 John Wiley & Sons, Ltd.

Lead poisoning caused by contaminated Cordyceps, a Chinese herbal medicine: two case reports

Two cases of lead poisoning, caused by the Chinese herbal medicine Cordyceps, were reported to the Department of Health in a laboratory-based blood lead surveillance program. Such unusual cases of lead poisoning have not been previously reported. These two patients took Cordyceps herbal medicine for treatment of underlying diseases. Loss of appetite and anemic signs of lead poisoning were manifested in one patient with a blood lead level of 130 μg/dl, while the other patient was asymptomatic with a blood lead level of 46 μg/dl. The lead content in the Cordyceps powder was found to be as high as 20 000 ppm. After cessation of intake in the asymptomatic patient, and cessation of intake and treatment with chelating agents in the symptomatic patient, the blood lead levels returned to normal range. This report raises concerns about lead poisoning from unusual herbal medicine worldwide.

Lead Poisoning Due to Hai Ge Fen-Reply

In Reply. —We appreciate the thoughtful reading given by Dr Hill and Ms Hill to our article describing a case of lead poisoning in a man who drank lead-contaminated tea made from a Chinese herbal mixture that containedhai ge fen. Certainly, the use of lead in antifouling paint applied to the bottom of ships could result in contamination of sea animals that ingest such paint. However, we believe it is unlikely that sea urchins were the source of lead for our patient. One of us (A.K.L.) consulted with herbalists at two large Chinese herbal shops in Chinatown in New York City and examined a number of texts in Chinese herbal medicines, including the popularCommonly Used Chinese Herbal Medicine Handbook, edited by Ding Hui Xiao.1None of these sources knew or referred to the use or recommended medicinal use of powder made from the outer covering of sea

The Treatment of Lead Poisoning from Gunshot Wounds with Succimer (DMSA)

Lead poisoning is an unusual complication of gunshot wounds that occurs when retained lead bullet fragments are in contact with body fluids capable of solubilizing lead. The epidemic of violence by gunfire may result in increasing numbers of lead poisoning cases from this exposure. The use of oral chelation for toxicity resulting from this mode of exposure has not been previously discussed. Cases of lead poisoning arising from bullet lead in the synovial cavity of the hip, synovial cavity of the chest, and pleural space are reported. A combination of surgical debridement and chelation therapy with oral succimer produced a satisfactory outcome in all three cases. Oral succimer may be a safe and effective chelation agent for treating lead toxicity in adults with high lead levels secondary to gun shot wounds.

Occupational health programme for lead workers in battery plants

The realization of problems resulting from the exposure to undue high lead levels of workers in lead-using industries, particularly in storage battery plants, has given rise to a new occupational health service, the so-called type specific (harmful agent specific) group occupational health. In 1988, the Korean Ministry of Labor designated the Institute of Industrial Medicine, Soonchunhyang University, as an authorized organization to take care of lead workers in lead industries. The following occupational health services are provided by the Institute: (i) physical health examination; (ii) biological monitoring with zinc protoporphyrin, urine δ-aminolevulinic acid and blood lead; (iii) respiratory protection with maintenance-free respirators; (iv) measurement of the environmental condition of workplaces; (v) health education. A three-year occupational health programme for lead workers has contributed to improvements in the working conditions of lead industries, particularly in large-scale battery plants, and has decreased the unnecessary high lead burden of workers through on-going medical surveillance with biological monitoring and health education schemes. The strong commitment of both employers and the government to improve the working conditions of lead industries, together with the full cooperation of lead workers, has served to reduce the high lead burdens of lead workers. This decreases the number of lead-poisoning cases and provides more comfortable workplaces, particularly in battery plants.

Demographic data and treatment of small companion animals with lead poisoning: 347 cases (1977-1986)

Summary Three hundred forty-seven cases of lead poisoning in small animals, diagnosed after 1976, were reviewed. The types of treatments used and their outcomes were analyzed. Changes in blood lead concentrations following various treatments, as well as the sources of lead exposure, were also reviewed. The geographic origins of the cases were traced, and demographic factors were studied to determine possible correlates that might explain the regional distribution of cases.

Clinical and laboratory findings in small companion animals with lead poisoning: 347 cases (1977-1986)

Summary Three hundred forty-seven cases of lead poisoning in small companion animals were reviewed. The yearly prevalence and overall incidence rates were examined for the 10 years before and after enactment of strict federal regulations pertaining to lead content in paint products. Biographical data, clinical signs, and laboratory results were analyzed for the 6 types of affected animals (ie, dogs, cats, birds, rabbits, a chinchilla, and a raccoon). Clinical and laboratory findings of these animals were then compared with findings of other studies of lead intoxication.

Lead-Shot Ingestion by Bald Eagles in Western Arkansas

A study was conducted on Holla Bend National Wildlife Refuge, in western Arkansas, to determine the extent to which bald eagles (Haliaeetus leucocephalus) wintering on the area were exposed to lead shot. Waterfowl comprised a significant portion of the diet; 61% of egested bald eagle castings contained waterfowl remains. Lead shot was found in 9 of 31 waterfowl carcasses that provide much of the winter food supply of bald eagles on the refuge. Lead shot was found in 7% of 82 egested castings, indicating that eagles do ingest lead shot in the process of feeding. In recent years, a great deal of interest has been directed toward lead-poisoning as a mortality factor among bald eagles (Haliaeetus leucocephalus; Pattee and Hennes, 1983; Feierabend and Myers, 1984). It has long been recognized that large numbers of waterfowl succumb annually to lead (Bellrose, 1975). How- ever, only recently has there been an attempt to compile and analyze information on the extent to which lead may affect bald eagles feeding on dead or crippled waterfowl. Feierabend and Myers (1984) reported that: 1) a growing body of evidence suggests that significant numbers of bald eagles die annually from lead- poisoning; 2) a minimum of 77 bald eagles died of lead-poisoning between 1966 and 1984; and 3) these data probably under-estimated the actual extent of the problem as most eagle carcasses are never recovered. Bald eagles are particularly vulnerable because population levels are low and because they readily feed on dead or crippled prey, particularly waterfowl (Pattee and Hennes, 1983). Arkansas is one of 27 states with documented cases of bald eagle mortality due to lead poisoning (Feierabend and Myers, 1984). Holla Bend National Wildlife Refuge, Pope Co., Arkansas, is a major wintering area for bald eagles and waterfowl and has had documented cases of lead poisoning in waterfowl. Therefore, the report by Feierabend and Myers (1984) listed Pope Co. as one of 89 counties nationwide where there is a high risk of bald eagles being poisoned by lead after ingesting lead pellets present in dead or crippled waterfowl. While there was a clear potential for poisoning of eagles wintering on Holla Bend, no quantitative data were available for assessing the extent to which eagles were actually exposed to lead shot. This report summarizes the results of a study conducted on Holla Bend during the winter of 1985-1986 to evaluate the extent to which wintering bald eagles were exposed to lead shot. The objectives of the study were to: 1) determine the frequency of occurrence of waterfowl in the diet of wintering bald eagles using the area; 2) evaluate the extent of lead shot in waterfowl carcasses on the area; and 3) determine the frequency of occurrence of lead shot in egested castings produced by bald eagles using Holla Bend.

Acute Lead Poisoning in Construction Workers: The Failure of Current Protective Standards

Construction workers who use oxyacetylene torches to cut lead-painted metal are at high risk of acute and subacute lead poisoning. Poisoning results from inhalation of submicron-diameter particles of lead fume generated in paint burning. We describe a series of 14 cases of lead poisoning in ironworkers cutting a lead-painted bridge in New York City. Peak blood lead levels ranged from 2.32 to 5.80 mumol/l (48-120 micrograms/dl). Median duration of employment was 4 wk. Two workers required chelation therapy. Personal (breathing zone) exposures to airborne lead ranged from 600 to 4,000 micrograms/m3. Construction workers are specifically exempted from the provisions of the U.S. Occupational Safety and Health Administration (OSHA) lead standard. The data from this study indicate that such exemption is not warranted. A need exists for improved protection of construction workers against occupational exposure to lead.

Potential exposure levels and health effects of neighborhood exposure to a municipal incinerator bottom ash landfill.

An investigation was conducted to assess the potential exposure levels and pursuant public health implications of neighborhood exposure to a municipal incinerator bottom ash landfill. This site received ash from a single incinerator without pollution control devices from 1954-1973. Soil was sampled for 10 heavy metals, polychlorinated dibenzodioxins, polychlorinated dibenzofurans, 2,3,7,8-tetrachlorodioxin and furan congeners, polychlorinated biphenyls, and polycyclic aromatic hydrocarbons. Soil concentrations for these substances were converted to estimates of exposure, health effects, and/or cancer risk by the application of a general exposure model and exposure/effect and exposure/risk models for specific substances. The results of soil analysis and modeling indicate that the level of lead detected on the site was considerably above the recommended levels of the Centers for Disease Control (CDC) and may lead to an elevated blood lead level in exposed children above that currently defining a case of lead poisoning. The potential for health effects resulting from exposure to other substances measured in the soil on this site is considered to be small, and no significant increased cancer risk is expected. Comparison of levels of various substances obtained at this site with levels obtained in fresh bottom ash in other studies suggests that these results may be applicable to exposures from other municipal incinerator bottom ash landfills.

Clinical evaluation on 5 cases of lead Poisoning

5 cases of lead poisoning were investigated clinically. Of the 5 patients, 4 were male and 1 was female. The causes of lead poisoning in 3 cases were ingestion of herb drug pills and in 2 cases were occupational poisoning. Chief complain at admission in 4 cases were in defined colicky abdominal pain and constipation. Only 1 case complained of dizziness and palpitation without gastrointestinal symptom. On peripheral blood, normocytic normochromic anemia (mean Hgb 9.2gm/dl), reticulocytosis (mean 4.7%) and basophilic stippling were found in 100% of patients. Bone marrow aspiration was done in 4 cases. Erythroid hyperplasia and basophilic stippling were found in all 4 cases. Mean M : E ratio was 0.7 : 1. The lead concentration in serum was in creased in 4 cases (80%) of patients. Lead concentration, deltaaminolevulinic acid concentration in 24 hours collected urine were in creased in 5 patients (100%). Qualitative test of coproporphyrin of urine was positive in all 5 cases. 3 patients treated with Ca-EDTA, abdominal pain was improved rapidly and hemoglobin level was in creased slowly.

Repeated surveillance of lead poisoning among children

In 1980, a survey of lead poisoning was carried out among 592 children aged 1 to 9 years living within 900 m of a lead smelter in Santo Amaro, Brazil. From 1980 to 1985, the lead smelter carried out a number of major improvements aimed at reducing environmental pollution. In January, 1985, a second survey was carried out among a sample of 250 children living in this same geographical area. The geometric mean of zinc protoporphyrin (ZPP) concentration in whole blood was 1.17 (standard deviation = 1.5) μmoll −1. Blood lead concentrations (PbB) determined in a subsample of 53 children had an arithmetic mean and standard deviation of 1.77 ± 1.00 μmoll −1, with 22 children showing PbB ⩾ 1.68 μmoll −1. Twenty-nine (11.6%) of the 250 children lived in houses where the lead content of the soil was > 10 000 ppm, and they presented higher ZPP levels than the rest of the population. Children with the habit of pica for soil had elevated ZPP levels. Comparing the results from the 1980 and 1985 surveys, slight improvements in ZPP and PbB levels were observed. However, new cases of lead poisoning are still occurring in the area. The soil is highly contaminated by lead and represents a long-lasting risk factor for child intoxication.

Lead poisoning in swans and sources of contamination in Ireland

A study of blood levels in mute swans Cygnus olor in Ireland has revealed that ingested lead pellets are responsible for acute lead poisoning. Forty‐two percent of blood samples from 890 live birds at one site showed elevated lead levels. X‐ray examination of live birds revealed the source of contamination to be ingested lead pellets. Urban birds were shown to have higher (P 0001) lead levels than rural birds, the blood lead levels of which were presumed to reflect natural background levels. Urban grass was shown to have elevated lead but this did not cause lead poisoning in Canada geese Branta canadensis. Post‐mortem examination has shown that 68% (n= 101) of all mute swans examined from a number of sites died from lead poisoning. Two sources of poisoning were identified; spent gunshot from a claypigeon shooting site at Lough Neagh, Northern Ireland, and lost or discarded anglers' weights at Cork Lough and at a fishing pond in Belfast, N.I. The first known case of lead poisoning in whooper swans Cygnus cygnus in Ireland is recorded which resulted from the ingestion of gunshot used almost two decades earlier. Aspects of the pathology of lead poisoned swans is discussed.

Chronic lead poisoning in steers eating silage contaminated with lead shot--diagnostic criteria.

Lead ingestion is one of the most common causes of poisoning in cattle. Toxicity results most commonly from the consumption of a single high dose of lead although cumulative toxicity resulting from the ingestion of small doses over a prolonged time also occurs. The sources of lead most commonly involved in disease outbreaks are paint, batteries, felt, linoleum and oil. It has traditionally been held that ingested metallic lead does not present a major toxicity risk to cattle because of its low solubility in the rumen and reticulum. More recent evidence suggests that lead shot, if present in silage, can induce toxicity when such silage is eaten by cattle. This communication describes a poisoning outbreak in steers eating lead shot contaminated grass silage. It presents and discusses the limitations of the criteria used for arriving at a diagnosis, including the use of whole blood amino levulinic acid dehydratase (ALAD) concentrations in fresh whole blood and after reactivation with dithiothreitol. Three are differences of opinion, in the literature, regarding the response of erythrocyte ALAD to ingested lead in the bovine. Consequently the results of a small lead feeding trial are also reported here. These results demonstrate a large ALAD response tomore » lead ingestion and justify the use of this test in the confirmation of field cases of lead poisoning in cattle such as the one reported here.« less

Occupational lead poisoning in Ohio: surveillance using workers' compensation data.

To determine the utility of workers' compensation (WC) data in a system for the surveillance of occupational lead poisoning, we reviewed workers' compensation claims for lead poisoning in Ohio. For the period 1979 through 1983, 92 (81 per cent) of the 114 claims attributed to lead met our case definition of lead poisoning. The likelihood that a company had a case of lead poisoning was strongly correlated with the number of claims against the company. Thirty companies accounted for the 92 cases; two companies accounted for 49 per cent of these. Inspection by the Occupational Safety and Health Administration (OSHA) occurred at 14 of these companies, all of which were cited for violations of the OSHA lead standard. Comparison of the Standard Industrial Classification (SIC) codes for the 14 companies inspected by OSHA with the 15 companies not inspected by OSHA revealed that OSHA inspected battery manufacturers, non-ferrous foundries, secondary smelters, and primary lead smelters, but not bridge painters, manufacturers of electronic components, mechanical power transmission equipment, pumps, and paints, nor a sheriff's office where firing range slugs were remelted to make new bullets. Neither the number of cases of lead poisoning at a company nor the size of a company was related to the likelihood of being inspected by OSHA. Claims for WC appear to be a useful adjunct to an occupational lead poisoning surveillance system; their usefulness should be compared to that of other systems such as laboratory reports of elevated blood lead levels in adults.

Lead poisoning from retained missiles. An experimental study.

The problem of lead poisoning from bullets has been investigated by surgically implanting discs of lead, each enriched in a different natural isotope, into the tissue of two mongrel dogs and monitoring by mass spectrometry the release of the lead into each animal's blood over the course of 3 years. Lead placed in the knee underwent vigorous attack by the synovial fluid, far in excess of what would be expected from corrosion theory, and reached a maximum concentration in blood 4-6 months after operation. Thereafter, lead concentration exponentially declined as the remaining fragments became encapsulated. The disc placed in muscle was sparingly soluble immediately following implantation. It is concluded that the greatest danger of lead poisoning from an injury involving many fragments having collectively a large surface area will occur within a month, and that the cases of lead poisoning resulting from bullets in joints that occur 5 or more years after injury are caused by continual wear of metal on a joint surface, storage of lead so released in the skeleton, and its subsequent resorption during a change in osteocyte activity.

Lead encephalopathy: Symptoms of a cerebellar mass lesion and obstructive hydrocephalus

The neurologic signs and symptoms of lead intoxication are quite varied. We review a case of lead poisoning in a 9-month-old child who presented clinically and radiographically with a posterior fossa mass effect and obstructive hydrocephalus. The predominance of edema of the cerebellum sufficient to achieve obstruction of the ventricular system represents a particularly unusual presentation of this disease process. Review of the literature for similar cases of lead encephalopathy is included.

Lead absorption in the mineral extraction industry.

Methods used to extract valuable minerals from ore and spoil tips in the Peak District are described. Venous blood samples were analysed for lead in miners and process workers to determine the extent of lead absorption. No excess absorption was found in the miners although it did occur amongst process workers employed in treatment plants. The risk of absorption is greatest in the dry grinding department and several cases of lead poisoning are described. Recommendations are made to control this hazard.

Greta and Azarcon: a survey of episodic lead poisoning from a folk remedy.

This paper reports on the use of two lead compounds, greta (PbO) and azarcon (Pb3O4) currently being used as folk remedies in Mexican-American communities. These compounds have produced cases of acute lead poisoning. The compounds are two of more than 100 treatments for the culture-bound syndrome empacho A survey of over 2,000 informants in 35 clinics indicates that at least one person in approximately ten percent of the participating households had been administered this remedy. A subsequent concurrent clinic and household survey demonstrated no significant difference in use by clinic populations as opposed to a community-based sample. Data are also presented on other potentially toxic substances used to treat empacho. The results of this research suggest that analysis of other ethnomedical systems should be undertaken to determine whether or not toxic substances are present in them as well.