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Samarghandian S, Shirazi FM, Saeedi F, Roshanravan B, Pourbagher-Shahri AM, Khorasani EY, Farkhondeh T, Aaseth JO, Abdollahi M, Mehrpour O. A systematic review of clinical and laboratory findings of lead poisoning: lessons from case reports. Toxicol Appl Pharmacol 2021; 429:115681. [PMID: 34416225 DOI: 10.1016/j.taap.2021.115681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 01/17/2023]
Abstract
Lead is one of the most toxic heavy metals in the environment. The present review aimed to highlight hazardous pollution sources, management, and review symptoms of lead poisonings in various parts of the world. The present study summarized the information available from case reports and case series studies from 2009 to March 2020 on the lead pollution sources and clinical symptoms. All are along with detoxification methods in infants, children, and adults. Our literature compilation includes results from 126 studies on lead poisoning. We found that traditional medication, occupational exposure, and substance abuse are as common as previously reported sources of lead exposure for children and adults. Ayurvedic medications and gunshot wounds have been identified as the most common source of exposure in the United States. However, opium and occupational exposure to the batteries were primarily seen in Iran and India. Furthermore, neurological, gastrointestinal, and hematological disorders were the most frequently occurring symptoms in lead-poisoned patients. As for therapeutic strategies, our findings confirm the safety and efficacy of chelating agents, even for infants. Our results suggest that treatment with chelating agents combined with the prevention of environmental exposure may be an excellent strategy to reduce the rate of lead poisoning. Besides, more clinical studies and long-term follow-ups are necessary to address all questions about lead poisoning management.
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Affiliation(s)
- Saeed Samarghandian
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
| | - Farshad M Shirazi
- Arizona Poison & Drug Information Center, The University of Arizona, College of Pharmacy and University of Arizona, Tucson, Arizona, USA
| | - Farhad Saeedi
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | | | | | - Tahereh Farkhondeh
- Faculty of Pharmacy, Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Jan Olav Aaseth
- Elverum, and Research Department, Innlandet Hospital, Norway University of Applied Sciences, Brumunddal, Norway.
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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Keshri S, Goel AK, Garg AK. Reversal of Acute Lead Encephalopathy in a Child. Cureus 2021; 13:e15155. [PMID: 34178489 PMCID: PMC8216578 DOI: 10.7759/cureus.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
Lead poisoning, fairly common in the 20th century, has decreased drastically in the last decade. Severe lead poisoning in the form of encephalopathy has a fatality rate of 28% to 45% and neurological sequelae in about 82%. We present the management of a case of lead encephalopathy that recovered without any significant neurological sequelae in a resource-limited setting. A previously healthy seven-year-old boy presented with complaints of falling unconscious on the ground while playing, followed by multiple episodes of seizures, vomiting, and altered sensorium. The patient had pallor, Glasgow coma score of E2V3M3, with features of raised intracranial pressure. Lead poisoning was suspected as the patient had four months of exposure to a battery recycling factory. Management of seizures and raised intracranial pressure was done. X-ray long bones showed lead lines at the metaphysis. Blood lead levels were highly elevated (139.96 mcg/dL). Investigations revealed iron deficiency anemia, vitamin D deficiency, and renal tubular injury in the form of proteinuria. D-penicillamine with supplements was started due to unavailability of other chelating agents. Encephalopathy improved, but patient had psychiatric symptoms of hallucinations and delusions. On the 12th day, CaNa2 EDTA was started, which resulted in significant improvement in the psychiatric symptoms. The patient had near-complete recovery in another one month, the patient being able to read, write, recite and speak as the pre-illness state. In conclusion, lead poisoning remains a significant health problem even today. Early recognition and management are of paramount importance in its outcome.
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Affiliation(s)
- Swasti Keshri
- Paediatrics Emergency Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Anil Kumar Goel
- Paediatrics, All India Institute of Medical Sciences, Raipur, IND
| | - Ankit Kumar Garg
- Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
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Abstract
Gastrointestinal disorders are one of the most common medical conditions that are comorbid with autism spectrum disorders. These comorbidities can cause greater severity in autism spectrum disorder symptoms, other associated clinical manifestations, and lower quality of life if left untreated. Clinicians need to understand how these gastrointestinal issues present and apply effective therapies. Effective treatment of gastrointestinal problems in autism spectrum disorder may result in marked improvements in autism spectrum disorder behavioral outcomes. This article discusses the gastrointestinal disorders commonly associated with autism spectrum disorders, how they present, and studied risk factors.
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Affiliation(s)
- Moneek Madra
- Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA,Institute of Human Nutrition, Columbia University Irving Medical Center, 630 West 168th Street, PH1512E, New York, NY 10032, USA
| | - Roey Ringel
- Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA,Columbia College, Columbia University, New York, NY, USA
| | - Kara Gross Margolis
- Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA; Institute of Human Nutrition, Columbia University Irving Medical Center, 630 West 168th Street, PH1512E, New York, NY 10032, USA.
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Nakhaee S, Mehrpour M, Mortazavi B, Weiss ST, Mehrpour O. Central nervous system infections versus lead toxicity in the differential diagnosis of encephalopathy. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:68. [PMID: 33088305 PMCID: PMC7554536 DOI: 10.4103/jrms.jrms_810_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/16/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahsa Mehrpour
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahareh Mortazavi
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Deputy of Research and Technology, Student Research Committee, Birjand University of Medical Science, Birjand, Iran
| | - Stephanie T Weiss
- Addiction Medicine Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Department of Medical toxicology, Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, CO, USA
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Abstract
Gastrointestinal disorders are one of the most common medical conditions that are comorbid with autism spectrum disorders. These comorbidities can cause greater severity in autism spectrum disorder symptoms, other associated clinical manifestations, and lower quality of life if left untreated. Clinicians need to understand how these gastrointestinal issues present and apply effective therapies. Effective treatment of gastrointestinal problems in autism spectrum disorder may result in marked improvements in autism spectrum disorder behavioral outcomes. This article discusses the gastrointestinal disorders commonly associated with autism spectrum disorders, how they present, and studied risk factors.
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Affiliation(s)
- Moneek Madra
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York
| | - Roey Ringel
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Columbia College, Columbia University, New York, New York
| | - Kara G. Margolis
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York
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Hauptman M, Stierman B, Woolf AD. Children With Autism Spectrum Disorder and Lead Poisoning: Diagnostic Challenges and Management Complexities. Clin Pediatr (Phila) 2019; 58:605-612. [PMID: 30938166 PMCID: PMC6982422 DOI: 10.1177/0009922819839237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marissa Hauptman
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA, USA
| | - Bryan Stierman
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA, USA
| | - Alan D. Woolf
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA, USA
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Abstract
A 2-year-old boy with a history of pica was admitted with vomiting and treated overnight for viral tonsillitis. A week later, he presented with a prolonged afebrile seizure and required intubation and ventilation. Antibiotics and acyclovir were started. Despite extensive investigations including MRI head, no cause was identified. Four days later, he deteriorated with signs of raised intracranial pressure. On day 5, blood lead concentration in the sample collected at admission was reported as grossly elevated, consistent with a diagnosis of severe lead poisoning from ingesting lead-containing paint at the family home. Chelation therapy was started but, unfortunately, he did not make a neurological recovery, and care was withdrawn. A serious case review identified a lack of awareness of lead poisoning and its relation to pica as a root cause. We report this case to share our experience and the importance of considering lead poisoning in children with pica.
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Affiliation(s)
- Amy Talbot
- Department of Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Carys Lippiatt
- Department of Specialist Laboratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Avanish Tantry
- Department of Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Abstract
Infants and children are at higher risk than adolescents and adults for exposure to environmental toxins via ingestion for a number of reasons: their smaller size (and proportionately larger dose of ingested toxins), their closer proximity to the ground, dirt, and indoor dust, their boundless curiosity and oral exploratory behaviors, pica habits that may persist into school-age for children with autism or other developmental delays, their proportionately larger daily water and milk intake, and food preferences that differ markedly from adolescents and adults. Children depend on adults to protect them and keep their home environment safe. Pediatric care providers can integrate environmental health topics into their well-child care practices, offering guidance and resources to parents concerned with reducing the risks to their children posed by hazards in their homes, daycare centers, preschools, schools, and the other environments in which they spend time. [Pediatr Ann. 2017;46(12):e466-e471.].
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Hauptman M, Bruccoleri R, Woolf AD. An Update on Childhood Lead Poisoning. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017; 18:181-192. [PMID: 29056870 PMCID: PMC5645046 DOI: 10.1016/j.cpem.2017.07.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Childhood lead poisoning is a multi-faceted, complex condition, which affects not only the child's health and well-being, but also the family's housing security, economic status, job security, and stress level. This review updates the emergency department clinician on the management of childhood lead poisoning. Infants and children are at higher risk than adults for lead exposure due to their smaller size and proportionately larger dose of ingested toxins, their proximity to ground dirt and indoor dust, their energy and curiosity, their oral exploratory and pica behaviors, their proportionately larger daily water and milk intake, and dietary preferences that differ markedly from those of adults. Pediatric health care providers working in the emergency department can provide medical management, as well as preventive counseling and guidance, to parents of children presenting with evidence of acute or chronic lead poisoning.
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Affiliation(s)
- Marissa Hauptman
- Pediatric Environmental Health Center, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA
| | - Rebecca Bruccoleri
- Pediatric Environmental Health Center, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA
- Program in Medical Toxicology, Boston Children's Hospital
| | - Alan D Woolf
- Pediatric Environmental Health Center, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA
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Rossignol DA, Genuis SJ, Frye RE. Environmental toxicants and autism spectrum disorders: a systematic review. Transl Psychiatry 2014; 4:e360. [PMID: 24518398 PMCID: PMC3944636 DOI: 10.1038/tp.2014.4] [Citation(s) in RCA: 292] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/15/2013] [Accepted: 01/06/2014] [Indexed: 11/21/2022] Open
Abstract
Although the involvement of genetic abnormalities in autism spectrum disorders (ASD) is well-accepted, recent studies point to an equal contribution by environmental factors, particularly environmental toxicants. However, these toxicant-related studies in ASD have not been systematically reviewed to date. Therefore, we compiled publications investigating potential associations between environmental toxicants and ASD and arranged these publications into the following three categories: (a) studies examining estimated toxicant exposures in the environment during the preconceptional, gestational and early childhood periods; (b) studies investigating biomarkers of toxicants; and (c) studies examining potential genetic susceptibilities to toxicants. A literature search of nine electronic scientific databases through November 2013 was performed. In the first category examining ASD risk and estimated toxicant exposures in the environment, the majority of studies (34/37; 92%) reported an association. Most of these studies were retrospective case-control, ecological or prospective cohort studies, although a few had weaker study designs (for example, case reports or series). Toxicants implicated in ASD included pesticides, phthalates, polychlorinated biphenyls (PCBs), solvents, toxic waste sites, air pollutants and heavy metals, with the strongest evidence found for air pollutants and pesticides. Gestational exposure to methylmercury (through fish exposure, one study) and childhood exposure to pollutants in water supplies (two studies) were not found to be associated with ASD risk. In the second category of studies investigating biomarkers of toxicants and ASD, a large number was dedicated to examining heavy metals. Such studies demonstrated mixed findings, with only 19 of 40 (47%) case-control studies reporting higher concentrations of heavy metals in blood, urine, hair, brain or teeth of children with ASD compared with controls. Other biomarker studies reported that solvent, phthalate and pesticide levels were associated with ASD, whereas PCB studies were mixed. Seven studies reported a relationship between autism severity and heavy metal biomarkers, suggesting evidence of a dose-effect relationship. Overall, the evidence linking biomarkers of toxicants with ASD (the second category) was weaker compared with the evidence associating estimated exposures to toxicants in the environment and ASD risk (the first category) because many of the biomarker studies contained small sample sizes and the relationships between biomarkers and ASD were inconsistent across studies. Regarding the third category of studies investigating potential genetic susceptibilities to toxicants, 10 unique studies examined polymorphisms in genes associated with increased susceptibilities to toxicants, with 8 studies reporting that such polymorphisms were more common in ASD individuals (or their mothers, 1 study) compared with controls (one study examined multiple polymorphisms). Genes implicated in these studies included paraoxonase (PON1, three of five studies), glutathione S-transferase (GSTM1 and GSTP1, three of four studies), δ-aminolevulinic acid dehydratase (one study), SLC11A3 (one study) and the metal regulatory transcription factor 1 (one of two studies). Notably, many of the reviewed studies had significant limitations, including lack of replication, limited sample sizes, retrospective design, recall and publication biases, inadequate matching of cases and controls, and the use of nonstandard tools to diagnose ASD. The findings of this review suggest that the etiology of ASD may involve, at least in a subset of children, complex interactions between genetic factors and certain environmental toxicants that may act synergistically or in parallel during critical periods of neurodevelopment, in a manner that increases the likelihood of developing ASD. Because of the limitations of many of the reviewed studies, additional high-quality epidemiological studies concerning environmental toxicants and ASD are warranted to confirm and clarify many of these findings.
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Affiliation(s)
- D A Rossignol
- Family Medicine, Rossignol Medical Center, Irvine, CA, USA
| | - S J Genuis
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R E Frye
- Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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