Lead Toxicity From Imported Jewelry

We summarize here the presentation and course of lead poisoning in a 1-year-old who ingested a lead-containing metallic medallion from India. We analyzed the medallion to determine its composition, using x-ray fluorescence spectroscopy and field emission scanning electron microscopy. A simple extraction test was used to estimate oral bioavailability. We used the US Environmental Protection Agency Integrated Exposure Uptake Biokinetic model to compare actual versus predicted blood lead levels. X-ray fluorescence analysis revealed the composition of the medallion to be: Lead 155 000 ppm (15%), copper 530 000 ppm (53%), nickel 49 000 ppm (4.9%), arsenic 22 000 ppm (2.2%), antimony 12 000 ppm (1.2%), tin 3000 ppm (0.3%), and silver 1300 ppm (0.13%). With a fixed ingestion of 7786 µg/d (estimated by simulated gastric extraction analysis) and assuming 50% bioavailability, Integrated Exposure Uptake Biokinetic modeling predicted the geometric mean blood lead level would increase from 2.05 µg/dL to 173.9 µg/dL. This patient had potentially life-threatening lead poisoning from an ingested piece of jewelry. The medallion contained 550 times the allowable content of lead in children's metallic jewelry sold in the United States. This case highlights the ubiquitous nature of lead in our global environment and the risk of exposure to novel sources, especially for children.