Acute lead poisoning: a diagnostic challenge in the emergency department

Bharath, G; Kappagantu, Vignan; Mathew, Robin; Jamshed, Nayer

doi:10.1136/bcr-2020-239740

Cited by 4 publications

(5 citation statements)

References 10 publications

(6 reference statements)

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“…However, given the patient’s history of herbal medicine intake and the presence of anaemia, lead poisoning was suspected. Multiple studies and case reports in the literature have documented cases of lead poisoning resulting from the use of traditional and herbal medicines 1–5…”

Section: Discussionmentioning

confidence: 99%

Unmasking herbal medication-induced lead poisoning in a geriatric patient with gastrointestinal symptoms

Eldhose,

Viggeswarpu,

Jambugulam

2023

BMJ Case Rep

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Lead poisoning, often associated with occupational exposure, can also arise from intake of traditional and herbal medicines with high lead content. Geriatric patients displaying gastrointestinal symptoms from such sources are frequently misdiagnosed. An individual in his 70s reported to our geriatric clinic with vomiting, constipation and anaemia. A meticulous history unveiled his recent intake of herbal remedies. Heavy metal assay indicated elevated lead levels in his blood and urine, consistent with the high lead content we measured in the herbal medication. Following supportive treatment, nutritional supplementation and chelation therapy with calcium disodium EDTA, he improved. Follow-up tests indicated a decrease in lead levels and resolution of anaemia. This case emphasises the importance of considering lead poisoning as a potential diagnosis in patients with unexplained symptoms, particularly when there is a history of herbal or alternative medication intake. Timely recognition and appropriate management can lead to better outcome.

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Section: Discussionmentioning

confidence: 99%

Unmasking herbal medication-induced lead poisoning in a geriatric patient with gastrointestinal symptoms

Eldhose,

Viggeswarpu,

Jambugulam

2023

BMJ Case Rep

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“…Saturnine colic is an infrequent cause of differential diagnosis of acute abdomen, which may appear in cases of acute lead poisoning, with blood lead levels exceeding 50-80 µg/dl (2,(19)(20)(21)(22). If undiagnosed, it can lead to avoidable surgeries, by mimicking acute appendicitis, perforated ulcer, acute pancreatitis or bowel obstruction (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

“…If undiagnosed, it can lead to avoidable surgeries, by mimicking acute appendicitis, perforated ulcer, acute pancreatitis or bowel obstruction (21)(22)(23). The abdominal pain is intense, colliquative, in the periumbilical area, resistant to usual antispastics (2,(20)(21)(22). The pain diminishes at profound palpation of the abdomen, with no tenderness or contracture, being a key element of differential diagnosis with surgical acute abdomen.…”

Section: Discussionmentioning

confidence: 99%

“…Lead intoxication is an environmental health problem, with extremely severe consequences upon the human body (1). Acute lead poisoning manifests clinically with intense acute abdominal pain, being a challenging diagnosis in emergency situations (2). Development a quick and reliable method for lead determination in blood and urine, is important in clinical practice, both in diagnostics, but also in monitoring chelating therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 90% of inhaled particulate lead is absorbed into the respiratory tract (7). Once absorbed, 99% is transported by the bloodstream and binds to hemoglobin in red blood cells (2,5).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Optimization of a GF‑AAS method for lead testing in blood and urine: A useful tool in acute abdominal pain management in emergency

Tudosie

Caragea²,

Popescu

et al. 2021

Exp Ther Med

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Suspicion of lead poisoning is confirmed by its concentration in blood and protoporphyrin red blood cells. At low concentrations, lead influences the synthesis of the heme in the sense of lowering it. Acute and chronic lead intoxication is extremely polymorphic in regards to its clinical manifestations, with digestive, hematological, cardiovascular, renal hepatic and neurological features. The aim of the study was to evaluate the presence of lead in human whole blood and urine harvested before and during chelation treatment in the case of lead poisoning. An atomic absorption spectroscopic method for the analysis of lead was developed using graphite furnace atomic absorption spectrophotometer (GF-AAS), Varian Spectra AA-880 with a hollow cathode lead lamp and a deuterium lamp for background correction, coupled to a GTA-100 atomizer and a programmable sample dispenser. Standard calibration solutions were used for the range 10-100 µg/l. The linearity range was 10.0 to 100.0 µg/l with the correlation coefficient of 0.999. We established that the method can be applied for the determination of lead in whole blood and urine, and the results obtained are useful for monitoring chelation therapy in cases of acute lead poisoning, a neglected cause of abdominal colic pain in an emergency situation.

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Lead and arsenic intoxications by traditional and alternative medicine: men are more sensitive than women

Gerke,

Seifert

2024

Naunyn-Schmiedeberg's Arch Pharmacol

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Traditional and alternative medicines are widely used around the world and include for example herbal medicine, Ayurveda, traditional Chinese medicine, and indigenous therapies. Due to the long history and the mostly natural origin of traditional remedies, it is often assumed that they are harmless, but in recent decades more and more case reports have been published in which traditional medicine has caused metal poisoning. This paper provides an analysis of published cases in which patients have suffered metal poisoning due to traditional or alternative medicines. A systematic literature search was performed on PubMed, whereby 210 patient cases from a total of 102 case reports and 30 case series were identified and then analyzed about various aspects. Most of the traditional medicines involved come from Asia and are mainly contaminated with lead and arsenic. The analyzed patient cases show a high degree of heterogeneity with regard to age, sex, intake reason, symptoms, and severity of intoxication. The metal intoxication itself and the cause of the poisoning often remained unrecognized for a long time, which resulted in many patients undergoing unnecessary diagnostic methods and ineffective therapeutic approaches before the correct diagnosis was made. The evaluation of the available patient cases revealed a higher sensitivity to metal poisoning in children compared to adults and a higher sensitivity in men compared to women. Anemia and basophilic stippling were frequently observed and became more common as the metal content in the blood increased. Hopefully, this paper raises awareness of the potential dangers of traditional and alternative medicines, both from the patient’s and the doctor’s perspective, so that in case of intoxication, treatment can be initiated quickly using the correct diagnostic methods. As ingested metals do not only circulate in the blood but also accumulate in soft tissues and bones, long-term monitoring is necessary to ensure that patients make a full recovery. Doctors should be aware that, in contrast to common belief, men are more sensitive to this type of intoxication than women, necessitating particular attention for diagnosis and treatment.

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Acute lead poisoning: a diagnostic challenge in the emergency department

Cited by 4 publications

References 10 publications

Unmasking herbal medication-induced lead poisoning in a geriatric patient with gastrointestinal symptoms

Unmasking herbal medication-induced lead poisoning in a geriatric patient with gastrointestinal symptoms

Optimization of a GF‑AAS method for lead testing in blood and urine: A useful tool in acute abdominal pain management in emergency

Lead and arsenic intoxications by traditional and alternative medicine: men are more sensitive than women

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