Lead Poisoning

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Title: Lead Poisoning

1
Case reports of lead poisoning Commonly
undiagnosed poisoning in Gujarat

2
INTRODUCTION

There are many traditional systems of medicine in
the world, each with different associated
philosophies and cultural origins.
Nowadays 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
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

4
The sources of lead exposure
5
Symptoms of Lead Poisoning
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.

7
Lead analysis in CEARCH

Lead Care-II Analyzer
8
SAMPLE PREPARATION ANALYZING

Take the blood sample of the patient in EDTA tube
or in Heparinized tube.
Take 50 µL blood in capillary and mix it in given
reagent with the Lead Care-II Analyzer .
Reagent contain an aqueous solution of hydrogen
chloride.
Mix it well until it becomes brown.
Calibrate the instrument with calibration button
provided.
Insert the sensor completely into the analyzer.
Now take the sample in dropper and put a one drop
on sensor.
Wait for 3 minutes, after 3 min. result is shown
on the screen of the analyzer.

9
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.

wrist drop
10

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.

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 .

12
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 (Fathers
qualification B.Sc Chemistry) by reading from
internet.
The child was investigated.

Saifan (3.5 years)
13
Following tests were carried out to know the
reason of illness
14

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 lt 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.

15
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.

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.

17
Conclusion

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.

18
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, Ankita parmar 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.