DÄ internationalArchive28-29/2009Lead Poisoning Due to Adulterated Marijuana in Leipzig Indication for chelator therapy should be defined critically: Indication for Chelator Therapy Should Be Defined Critically

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Lead Poisoning Due to Adulterated Marijuana in Leipzig Indication for chelator therapy should be defined critically: Indication for Chelator Therapy Should Be Defined Critically

Dtsch Arztebl Int 2009; 106(28-29): 479; DOI: 10.3238/arztebl.2009.0479a

Muttray, A

LNSLNS In contrast to the authors' assumptions, lead intoxications have not become a rarity. According to Germany's statutory accident insurance, in 10 years more than 100 cases of lead intoxication have been recognized as an occupational disease. The real number can be assumed to be much higher. The remark that lead intoxication can be diagnosed on the basis of a lead seam is erroneous in this form. The seam is often not present and is thus not a reliable symptom. Further, the differential diagnosis to tartar (odontolithiasis) deposits is sometimes difficult. A detailed and environmental medical history mostly provides diagnostic pointers, which should be followed by measuring lead concentration in the blood.

Nausea and vomiting should be included among the gastrointestinal symptoms of lead poisoning. Symptomatic treatment for abdominal cramps can be delivered by local application of heat.

In the section entitled "Diagnosis", the authors say that the whole blood concentration indicates only acute exposure from the preceding 35 days. They are obviously confusing this with the initial (rapid) half life. In actual fact, blood lead concentrations can be increased for much longer than 35 days (1).

We don't follow the suggested chelator therapy in men with a blood lead concentration >250 µg/L, and in women even at >150 µg/L. In adults, intoxications requiring treatment do not occur in such blood concentrations. The clinical symptoms have to be taken into consideration when the indication is defined. Side effects of non-indicated chelator therapy may result in court proceedings on a charge of bodily harm.

DOI: 10.3238/arztebl.2009.0479a


Prof. Dr. med. Axel Muttray
Institut für Arbeits-, Sozial- und Umweltmedizin
Universitätsmedizin der Johannes Gutenberg-Universität Mainz
Obere Zahlbacherstr. 67, 55131 Mainz, Germany
amuttray@uni-mainz.de
1.
Skervfing S, Bergdahl IA. Lead: In: Nordberg GF, Fowler BA, Nordberg M, Friberg LT (Hrsg.): Handbook on the toxicology of metals. Amsterdam: Elsevier 2007; 599–643. MEDLINE
2.
Busse FP, Fiedler GM, Leichtle A, Hentschel H, Stumvoll M: Lead poisoning due to adulterated Marijuana in Leipzig [Bleiintoxikationen durch gestrecktes Marihuana in Leipzig]. Dtsch Arztebl Int 2008; 105: 757–62.
1. Skervfing S, Bergdahl IA. Lead: In: Nordberg GF, Fowler BA, Nordberg M, Friberg LT (Hrsg.): Handbook on the toxicology of metals. Amsterdam: Elsevier 2007; 599–643. MEDLINE
2. Busse FP, Fiedler GM, Leichtle A, Hentschel H, Stumvoll M: Lead poisoning due to adulterated Marijuana in Leipzig [Bleiintoxikationen durch gestrecktes Marihuana in Leipzig]. Dtsch Arztebl Int 2008; 105: 757–62.