Elevated blood lead levels in urban moonshine drinkers

During a study of problem drinking, we found that surprisingly large numbers of emergency department patients reported moonshine consumption. Because of sporadic reports of moonshine-associated lead toxicity in rural areas, we suspected that urban ED patients might have previously unidentified elevated blood lead levels caused by moonshine consumption. We initiated an active screening program to identify patients with moonshine-associated elevated blood lead levels.

We performed a prospective case-finding effort at a large urban ED in Atlanta, GA, screening all patients admitted to the ED for a 6-month period during times when study personnel were available. Patients reporting moonshine consumption within the preceding 5 years were asked to participate. After written informed consent, subjects completed a structured interview administered by one of the investigators, and blood was obtained for determination of a whole blood lead level. We recorded the numbers of patients reporting moonshine consumption, time of most recent consumption, other potential sources of lead exposures, and whole blood lead levels.

Of 49 patients reporting consumption of moonshine within the past 5 years, 25 (51%) of 49 had elevated blood lead levels (>15 microg/dL), with 15 (31%) of 49 having extremely elevated blood lead levels (>50 microg/dL). Recent moonshine consumption (within the past month) was reported by 38 (78%) of 49 patients. Of these 38 recent consumers, 23 (61%) had elevated lead levels compared with only 2 (18%) of 11 of those reporting more remote consumption (risk difference 42%; 95% confidence interval 15% to 70%).

A high percentage of patients who reported moonshine consumption had elevated blood lead levels. Emergency physicians should consider screening to determine the prevalence of moonshine consumption in their practice settings, as well as the possibility of lead intoxication among patients with suggestive symptoms. All patients reporting moonshine consumption within the past 5 years should be tested for lead exposure.