The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #74778

Geert van Waveren, MD MPH, Department: Dept. of Pediatrics, BovenIJ Hospital, Statenjachtstraat 1, Amsterdam, 1034 CS, Netherlands, 31(0)20 6346118, g.vanwaveren@bovenij.nl and Tessa Ververs, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands.

Case presentation: On account of vague complaints, a 4½ -year-old girl was referred to a pediatrician. The results of a physical examination did not show any abnormalities. Routine haematological analysis showed a slightly reduced Hb of 6.3mmol/1, MCV 75 fl and a serum ferritin of 6 µg/l. Besides a mild form of eosinophilia (12% eosinophils), the peripheral blood smear showed poikilocytosis and basophilic stippling of the erythrocytes. Based on this result the blood lead concentration was checked. This proved to be 660 µg/l, which suggests an exceptionally high degree of exposure. In and around the house there was no immediately obvious source of exposure. The blood lead concentrations of the other members of the family were within acceptable limits. Finally the source was found to be a lead curtain weight in her bedroom on which she sucked for 1.5 years. Results: The first action taken was the removal of the source of exposure. Besides, there was the possibility of chelation therapy. In this case the level of the blood lead concentration was within a range (450-700 µg/l) which justifies chelation therapy. Succimer (a DMSA analogue) was given twice for a period of 19 days as oral chelation therapy. The blood lead concentration then dropped but rose again due to redistribution from deeper compartments. Six months after the removal of the source of exposure and the two treatments, the blood lead concentration had fallen below 450 µg/l and nine years later below 90 µg/l. Conclusion: As lead compounds taste sweet, it is advisable to be prepared for the possibility of children being unexpectedly exposed to them.

Learning Objectives:

• The detection of a case of possible exposure to lead due to environmental pollution will usually be a reason for starting an investigation. In individual cases of intoxication without any immediate indication as to the source of exposure, the diagnosis will be made because certain symptoms point in this direction or as a result of chance discoveries made during additional examination conducted for different reasons.

Keywords: Lead, Children's Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.