Rare cases of severe life-threatening lead poisoning due to accident or chronic occupational exposure to lead and manganese: Diagnosis, treatment, and prognosis

Background: Chronic long-term, low-dose environmental and occupational exposure to lead (Pb) has been extensively studied in large cohorts worldwide among general populations, miners, smelters, or battery workers. However, studies on severe life-threatening Pb poisoning due to accidental or chronic occupational exposure to Pb and manganese (Mn) were rarely reported. Methods: We present one case of acute severe Pb poisoning and compare it with another severe chronic occupational exposure case involving Pb and Mn. A 27-year-old woman mistakenly took a large quantity of pure Pb powder as an herbal remedy; she developed abdominal colic, severe nausea, vomiting, fatigue, and cutaneous and sclera icterus. Laboratory tests showed her blood lead level (BLL) of 173.5 µg dL−1 and urinary lead level (ULL) of 1240 µg dL−1. The patient was diagnosed with acute Pb poisoning and acute liver failure. In another chronic exposure case, a 56-year-old man worked in a Pb and Mn smelting factory for 15 years. He was brought to the emergency room with severe nausea, vomiting, and paroxysmal abdominal colic, which was intolerable during the onset of pain. His BLL was 64.8 µg dL−1 and ULL was 38 µg dL−1, but his blood and urinary Mn levels were normal. The patient was diagnosed with chronic Pb poisoning. Both patients received chelation therapy with calcium disodium ethylene-diamine-tetraacetate (CaNa2EDTA). The woman with acute severe Pb intoxication recovered well and was discharged from the hospital after treatment, and the man who survived severe Pb poisoning was diagnosed with lung cancer. Conclusion: Clinical manifestations of acute and chronic severe Pb poisoning are different. Chelation therapy with CaNa2EDTA is proven to be an effective life-saving therapy in both cases by reducing BLL. Occupational exposure to both Pb and Mn does not appear to increase Mn neurotoxicity; however, the probability that co-exposure to Mn may increase Pb toxicity in the same patient cannot be excluded.

[1]  Yuanzhong Zhou,et al.  The association of bone, fingernail and blood manganese with cognitive and olfactory function in Chinese workers. , 2019, The Science of the total environment.

[2]  R. Garnier,et al.  A comparative study of edetate calcium disodium and dimercaptosuccinic acid in the treatment of lead poisoning in adults , 2018, Clinical toxicology.

[3]  H. Vossoughinia,et al.  Severe Abdominal Pain Caused by Lead Toxicity without Response to Oral Chelators: A Case Report , 2015, Middle East journal of digestive diseases.

[4]  Wei Zheng,et al.  Manganese Toxicity Upon Overexposure: a Decade in Review , 2015, Current Environmental Health Reports.

[5]  T. Guilarte.  Manganese-induced parkinsonism does not involve degeneration of nigrostriatal dopaminergic neurons: Evidence from genetic mutations and environmental exposure in humans and non-human primates , 2015 .

[6]  A. Buha,et al.  Insight into the oxidative stress induced by lead and/or cadmium in blood, liver and kidneys. , 2015, Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association.

[7]  Wei Zheng,et al.  Manganese accumulation in bone following chronic exposure in rats: steady-state concentration and half-life in bone. , 2014, Toxicology letters.

[8]  F. Goñi,et al.  Effects of chronic and acute lead treatments on the biophysical properties of erythrocyte membranes, and a comparison with model membranes☆ , 2013, FEBS open bio.

[9]  T. Guilarte,et al.  Mechanisms of lead and manganese neurotoxicity. , 2013, Toxicology research.

[10]  M. J. Haider,et al.  Studies on battery repair and recycling workers occupationally exposed to lead in Karachi. , 2013, Roczniki Panstwowego Zakladu Higieny.

[11]  Joel Schwartz,et al.  Associations of Early Childhood Manganese and Lead Coexposure with Neurodevelopment , 2011, Environmental health perspectives.

[12]  Wei Zheng,et al.  Biomarkers of manganese intoxication. , 2011, Neurotoxicology.

[13]  Robert O. Wright,et al.  Association of Cumulative Lead Exposure with Parkinson’s Disease , 2010, Environmental health perspectives.

[14]  Jing Chen,et al.  Manganese exposure among smelting workers: relationship between blood manganese-iron ratio and early onset neurobehavioral alterations. , 2009, Neurotoxicology.

[15]  C. Mulder,et al.  Hepatic morphopathologic findings of lead poisoning in a drug addict: a case report. , 2009, Journal of gastrointestinal and liver diseases : JGLD.

[16]  Wei Zheng,et al.  Evidence for altered hippocampal volume and brain metabolites in workers occupationally exposed to lead: a study by magnetic resonance imaging and (1)H magnetic resonance spectroscopy. , 2008, Toxicology letters.

[17]  M. Bleecker,et al.  Impact of cognitive reserve on the relationship of lead exposure and neurobehavioral performance , 2007, Neurology.

[18]  R. Shiri,et al.  Lead poisoning and recurrent abdominal pain. , 2007, Industrial health.

[19]  Roberta F. White,et al.  Cognitive deficits and magnetic resonance spectroscopy in adult monozygotic twins with lead poisoning. , 2004, Environmental health perspectives.

[20]  Jenny R. Roberts,et al.  Pulmonary Responses to Welding Fumes: Role of Metal Constituents , 2004, Journal of toxicology and environmental health. Part A.

[21]  W. Zheng,et al.  Comparative toxicokinetics of manganese chloride and methylcyclopentadienyl manganese tricarbonyl (MMT) in Sprague-Dawley rats. , 2000, Toxicological sciences : an official journal of the Society of Toxicology.

[22]  J. Graziano,et al.  Bioavailability of soilborne lead in adults, by stable isotope dilution. , 1998, Environmental health perspectives.

[23]  L. Hagmar,et al.  Cumulative lead exposure in relation to mortality and lung cancer morbidity in a cohort of primary smelter workers. , 1997, Scandinavian journal of work, environment & health.

[24]  E. Orhede.  Nordic cooperation in research on the work environment. , 1994, Scandinavian journal of work, environment & health.

[25]  C. Couinaud,et al.  The "lead-induced colic" syndrome in lead intoxication. , 1985, Surgery annual.

[26]  D. K. Saxena,et al.  Effects of pre- and postnatal combined exposure to Pb and Mn on brain development in rats. , 1983, Industrial health.

[27]  G. S. Shukla,et al.  Concentrations of Striatal Catecholamines in Rats Given Manganese Chloride Through Drinking Water , 1981, Journal of neurochemistry.

[28]  M. Moore,et al.  Acute Lead Poisoning: An Unusual Cause of Hepatitis , 1979, Scottish medical journal.

[29]  J. White.  Lead and haemoglobin synthesis: a review. , 1975, Postgraduate medical journal.

[30]  J. White,et al.  Annotation , 1975 .

[31]  J. White,et al.  Lead and the red cell. , 1975, British journal of haematology.

[32]  R. Mccallum,et al.  The lead hazard in shipbreaking: The prevalence of anaemia in burners. , 1968, The Annals of occupational hygiene.

[33]  S. E. Gould,et al.  EFFECT OF LEAD THERAPY ON BLOOD CELLS OF CANCER PATIENTS , 1937 .