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An unexplained case of elevated blood lead in a Hispanic child
Larry K Lowry1, Debra C Cherry, Charles F Brady
1Southwest Center for Pediatric Environmental Health, The University of Texas Health Center at Tyler, Tyler, Texas 75708-3154, USA. larry.lowry@uthct.edu
Insights
A pediatric case reveals persistent high blood lead levels (BLLs) in an infant despite no obvious environmental sources. Maternal pica during pregnancy may explain the child's elevated BLLs and slow lead release.
Area of Science:
- Environmental Health
- Pediatric Toxicology
- Public Health
Background:
- Lead exposure in children poses significant health risks.
- Identifying sources of lead exposure is crucial for effective intervention.
- Pediatric blood lead levels (BLLs) require careful monitoring and management.
Observation:
- A 6-month-old infant presented with elevated BLLs (41 microg/dL) unresponsive to outpatient chelation.
- Despite extensive home investigations, no common lead sources (paint, dust, water) were identified.
- Maternal BLL was mildly elevated (14 microg/dL), and she admitted to using lead-glazed Mexican pottery for cooking beans.
Findings:
- The infant's BLLs remained high (40-42 microg/dL) until 13 months, with a slow decline observed later (28 microg/dL at 15 months).
- The mother's BLL also decreased (9 microg/dL at 15 months), suggesting a shared but diminishing exposure or release.
- The persistent and slow-releasing nature of lead in the child suggested mobilization of lead stores, potentially acquired in utero.
Implications:
- Maternal pica during pregnancy is a potential, often overlooked, source of fetal lead exposure.
- Lead stored in maternal bone can be released during pregnancy and lactation, affecting the infant.
- This case highlights the importance of considering maternal history, including pica, in pediatric lead poisoning investigations.
Abstract:
A 6-month-old child presented to a local pediatrician with an elevated blood lead level (BLL) of 41 microg/dL. The child was treated as an outpatient for chelation therapy by a toxicologist. Subsequent BLLs obtained at 8 and 13 months of age were 40 microg/dL and 42 microg/dL, respectively. Siblings and family members had BLLs < 5 microg/dL except for the mother, who had a BLL of 14 microg/dL when the child was 6 months of age. Home inspections and phone calls to the family revealed no sources of lead from paint, dust, toys, mini-blinds, keys, food, water, or any take-home exposure. The family denied use of folk remedies such as Greta and Azarcon. The child was breast-fed, but the mother's BLL was not sufficiently high to explain the elevated BLL in the child. Housekeeping was excellent. The mother did admit to cooking beans in Mexican pottery (pieces found outside were positive for lead), but she discontinued use after the initial lead check at 6 months. The bean pot was not a likely source, as none of the family had elevated BLLs including a 5-year-old sister. Follow-up testing of blood lead when the child was 15 months of age revealed values of 28 microg/dL for the child and 9 microg/dL for the mother. Subsequent testing of the child shows a slow decline. The slow release of lead suggests depletion of bone stores acquired during pregnancy, possibly due to pica behavior of the mother during pregnancy.
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