Increased blood lead levels in severe smoke inhalation

Lead-containing paint is common in structures built before 1977. Heated lead in burning paint can be aerosolized and absorbed directly into the bloodstream through the lungs. Acute lead intoxication has been reported in this setting. The objective of this study was to determine if victims of severe smoke inhalation secondary to closed-space fires have clinically important elevated blood lead levels. A case-control study, with a 2:1 ratio of cases to controls, was matched for age and sex. Cases were drawn from a prospective convenience sample of intubated victims of closed-space fires presenting to the ED of an urban tertiary burn center. Cases had blood lead levels obtained 24 hours postexposure. Matched control subjects had blood lead levels obtained during ED evaluation for a complaint unrelated to smoke inhalation. The difference between mean lead levels for cases and control subjects was expressed with a 95% confidence interval (CI). Among 22 cases, the mean lead level was 6.64 mug/dL (standard deviation [SD], 4.14 mug/dL). Among the 44 matched control subjects, mean lead level was 2.89 mug/dL (SD, 1.65 mug/dL). The mean difference between cases and control subjects was 3.75 mug/dL (95% confidence interval, 1.86-5.64). Although severe smoke inhalation is associated with a more than 2-fold statistically significant increase in blood lead levels, there is no evidence to suggest that these elevations are clinically important.