An unusual cause of recurrent abdominal pain

A Study of Maternal and Umbilical Cord Blood Lead Levels in Pregnant Women

Lead is a highly toxic element which can cross the placental barrier and enter the fetus during pregnancy. Parental lead exposure has adverse effect on infant as well as on maternal health. As part of our program to investigate the lead poisoning in human population we investigated the maternal blood lead levels (MBLL) and umbilical cord blood lead (UBLL) levels in 200 pregnant women and collected their socio-demographic details. In the study we found high lead levels in both maternal and umbilical cord blood samples. The results showed 47.5% maternal blood (n = 95) detected with lead while 38.5% umbilical cord blood (n = 77) samples had lead concentration higher than that of reference range of ≤ 5 µg/dL. We also found that the Spearman's correlation coefficient (rs) revealed a strong positive correlation between the MBLL and UBLL (rs = 0.63). The results from socio-demographic questionnaire demonstrated that the recent home painting (p = 0.002) and residing close proximity to traffic congestion (p = 0.05) were significantly associated with MBLL. Education, mother age, fuel and water sources were not significantly associated with MBLL. Iron and calcium deficiency along with tiredness, lethargy, abdominal pain were also reported in women having high lead level > 5 µg/dL. Concludingly, on the basis of results obtained it may be stated that we found elevated BLLs in both pregnant women as well as in umbilical cord blood. The prevalence of elevated lead levels in mothers will expose the fetus to lead through placental barriers mobilization and it can have long term adverse effects on the developing fetus. Therefore, it is recommended that screening of blood lead levels be carried out in high-risk women based on their social, occupational, environmental, and individual factors. In addition, stringent regulations on lead-based products are also required from government agencies/authorities to reduce environmental lead burden and toxicity. Moreover, public awareness programs should be organized on hazardous effect of lead.

Intravenous calcium Gluconate alleviates Lead-induced abdominal pain, a randomized clinical trial

BACKGROUND

In 2016, in a lead poisoning outbreak in Iran, physicians reported thousands of opium users who presented to emergency departments (EDs) with intractable severe abdominal pain which did not respond to any narcotic medication. During the same period of time, we investigated the efficacy of intravenous calcium gluconate in alleviating lead-induced abdominal pain.

METHODS

In a single-center, single blinded, randomized controlled trial, a convenient sample of adult opium-addicted patients who presented to an academic ED with abdominal pain and had an initial diagnosis of lead poisoning were included and randomly subjected to two treatment groups receiving conventional treatment (morphine 0.1 mg/kg + normal saline; group 1) and conventional treatment plus 1 g of intravenous calcium gluconate (group 2) to alleviate their abdominal pain. The visual analogue scale (VAS) was determined by each patient (0 to 100 mm) before treatment, and 15, 30, and 60 min after intervention.

RESULTS

A total of 50 patients (25 in each group) were enrolled. Blood lead levels, VAS scores before treatment, and mean administered dose of morphine were similar between the two groups. After treatment, mean VAS score dropped to 64.7± 10.4 vs. 67.1± 10.9 at 15 min (P = 0.437), 64.6± 10.9 vs. 58.0 ± 11.2 at 30 min (P = 0.041), and 63.8± 10.7 vs. 53.6± 10.9 at 60 min (P = 0.002) in groups 1 and 2, respectively.

CONCLUSION

Intravenous calcium gluconate administration along with morphine can improve abdominal pain in lead poisoning due to the ingestion of lead-contaminated opium. Further interventional studies are recommended to see if response to calcium salts in suspected lead-induced abdominal pain can rule in lead toxicity.

TRIAL REGISTRATION

IRCT20171009036661N2. Registered 27 May 2018 - Retrospectively registered.

Lead Exposure in Different Organs of Mammals and Prevention by Curcumin-Nanocurcumin: a Review

Chronic lead exposure is related to many health diseases in mammals. Exposure to lead forms reactive oxygen species reducing body antioxidant enzymes inflicting injury to numerous macromolecules or cell necrosis. Recent studies have revealed oxidative stress as the vital mechanism for lead toxicity. Lead is found to be toxic to several organ systems such as hematopoietic, skeletal, renal, cardiac, hepatic, and reproductive systems and extremely toxic to the central nervous system (CNS). Curcumin, an active ingredient of the dietary spice, and nanocurcumin, a nanoform of curcumin, are found to decrease toxicity due to lead in various organ systems in mouse models. Higher bioavailability, chelating property, and retention time of nanocurcumin over bulk curcumin may pave the way to expand the utility of nanocurcumin to remove lead toxicity from various organ systems within humans.

Extreme gastric dilation caused by chronic lead poisoning: A case report

Lead is a toxic metal that affects many organ systems and functions in humans. In the majority of adults, chronic lead poisoning comes from exposures to work places and can occur in numerous work settings, such as manufacturing, lead smelting and refinement, or due to use of batteries, pigments, solder, ammunitions, paint, car radiators, cable and wires, certain cosmetics. In some countries, lead is added to petrol. We present a rare case of gastric dilation caused by long-term petrol ingestion. A 16-year-old young man was admitted to our hospital due to a 6-mo history of exhaustion, dizziness, nausea, abdominal cramps and constipation. X-ray examination revealed dilated stomach descending into the pelvis and small bowel distension. After a long clinical observation, we found that the reason for the chronic lead poisoning of the patient was due to a 3-year history of petrol ingestion. The patient spontaneously recovered and stomach returned to its normal position and size. Lead poisoning should be taken into consideration in all unexplained cases of gastric dilation.

Lead poisoning and recurrent abdominal pain

Severe abdominal colic because of lead poisoning is an uncommon condition in adults. The diagnosis of lead toxicity is often delayed and abdominal pain is mistaken for acute abdomen. We describe three blood brothers who were involved in pottery glazing and suffered from repeated episodes of severe abdominal pain, nausea, vomiting, constipation and anemia due to lead toxicity. The patients had a history of several hospitalizations and one or two unnecessary laparotomies. One patient had wrists drop and weakness of the fingers extensors. All three patients had microcytic microchromic anemia with basophilic stippling of the erythrocytes, lead lines in X-ray of the knee joint and high blood lead levels. A diagnosis of lead poisoning was made and a course of chelating treatment started. Motor neuropathy, anemia and all gastrointestinal symptoms disappeared. Our report highlights the importance of taking a detailed occupational history and considering lead poisoning in the differential diagnosis of acute abdominal colic of unclear cause.