CHRONIC LEAD INTOXICATION IN A 4-YEAR
OLD CHILD CAUSED BY PROLONGED EXPOSURE TO AN UNEXPECTED SOURCE
Van Waveren G¹, Ververs FFT², Van Dijk
A²
1 Dept. of
Paediatrics, BovenIJ Hospital Amsterdam, The Netherlands
2 Dept. of Pharmacy,
University Medical Center Utrecht, The Netherlands
Objective: 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.
Case presentation: On account of vague complaints,
a 4½ -year-old girl was referred to a paediatrician. 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 seven years later below 150 µg/l.
Conclusion: As lead compounds taste sweet, it is
advisable to be prepared for the possibility of children being unexpectedly
exposed to them.