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Severe congenital lead poisoning in a preterm infant due to a herbal remedy

Paul A Tait, Amish Vora, Simon James, D James Fitzgerald and Beverly A Pester
Med J Aust 2002; 177 (4): 193-195.

Chronic lead poisoning may manifest clinically as abdominal pain, constipation, proteinuria, haematuria, peripheral neuropathy and muscle weakness.1 With more significant lead poisoning, encephalopathy may occur.2 Sustained blood lead levels of over 0.5 μmol/L in early childhood are likely to be associated with intellectual underperformance.3 However, congenital lead poisoning and its subsequent management has rarely been reported in preterm infants.

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  • Paul A Tait1
  • Amish Vora2
  • Simon James3
  • D James Fitzgerald4
  • Beverly A Pester5

  • 1 Pharmacy Department, Women's and Children's Hospital, North Adelaide, SA.
  • 2 Neonatal Unit, Flinders Medical Centre, Bedford Park, SA.
  • 3 Environmental Health Branch, Department of Human Services, Adelaide, SA.


Acknowledgements: 

The authors gratefully acknowledge Dr Stephen Rothenberg, of Charles Drew University, Los Angeles, for discussion of fetal and maternal blood lead levels; Mike Stevenson, of Berri/Barmera Council, for the environmental audit; Sam Mangas, for assistance with the source investigation; and Bill Dollman and Dr Brian Priestly, for discussions on the regulation of herbal remedies in Australia.

Competing interests:

None identified.

  • 1. Fuhrman BP. The acutely ill child. In: Nelson's essentials of paediatrics. 2nd ed. Philadelphia: WB Saunders, 1994: 91-122.
  • 2. Klaassen CD. Heavy metals and heavy-metal antagonists. In: Goodman and Gilman's The pharmacological basis of therapeutics. 10th ed. New York: McGraw Hill, 2001: 1851-1875.
  • 3. Statement issued by 115th session of the National Health and Medical Research Council, 2 June 1993. Revision of the Australian guidelines for lead in blood and lead in ambient air. Available at: <http://www.nhmrc.gov.au/publications/synopses/eh8syn.htm>. Link updated August 2005.
  • 4. Parfitt K, editor. Martindale: the complete drug reference. 32nd ed. London: Pharmaceutical Press, 1999.
  • 5. Treatment guidelines for lead exposure in children (RE9529). American Academy of Pediatrics Committee on Drugs. Pediatrics 1995; 96: 155-160.
  • 6. Graziano JH, Lolacono NJ, Meyer P. Dose-response study of oral 2,3-dimercaptosuccinic acid in children with elevated blood lead concentrations. J Pediatr 1988; 113: 751-757.
  • 7. Graziano JH, Lolacono NJ, Moulton T, et al. Controlled study of 2,3-dimercaptosuccinic acid for management of childhood lead intoxication. J Pediatr 1992; 120: 133-139.
  • 8. 19th Australian Total Diet Survey. A total diet survey of pesticide residues and contaminants. Canberra: Australian New Zealand Food Authority, 2001.
  • 9. Howard H. Heavy metal poisoning. In: Harrison's principles of internal medicine. 14th ed. New York: McGraw-Hill; 1998: 2564-2569.
  • 10. Timpo AE, Amin JS, Casalino MB, Yuceoglu AM. Congenital lead intoxication. J Pediatr 1979; 94: 765-767.
  • 11. Knecht CD, Crabtree J, Katherman A. Clinical, clinicopathologic, and electroencephalographic features of lead poisoning in dogs. J Am Vet Med Assoc 1979; 175: 196-201.
  • 12. Goyer RA. Transplacental transport of lead. Environ Health Perspect 1990; 89: 101-105.
  • 13. Marcus AH. Multicompartment kinetic model for lead. III. Lead in blood plasma and erythrocytes. Environ Res 1985; 36: 473-489.
  • 14. Therapeutic Goods Administration. Australian Department of Health and Ageing. 2002. Available at: <http://www.tga.gov.au/cm/cm.htm>. Link updated August 2005.
  • 15. McElvaine MD, Harder EM, Johnson L, et al. Lead poisoning from the use of Indian folk medicines. JAMA 1990; 264: 2212-2213.
  • 16. Dunbabin DW, Tallis GA, Popplewell PY, Lee RA. Lead poisoning from Indian herbal medicine (Ayurveda). Med J Aust 1992; 157: 835-836.
  • 17. van Vonderen MGA, Klinkenberg-Knol EC, Craanen ME, et al. Severe gastrointestinal symptoms due to lead poisoning from Indian traditional medicine. Am J Gastroenterol 2000; 95: 1591-1592.
  • 18. Shaltout A, Yaish SA, Fernando N. Lead encephalopathy in infants in Kuwait. Ann Trop Paediatr 1981; 1: 209-215.
  • 19. Rahman H, Al Khayat A, Menon N. Lead poisoning in infancy – unusual causes in the U.A.E. Ann Trop Paediatr 1986; 6: 213-217.
  • 20. Lead poisoning associated with use of traditional ethnic remedies — California, 1991–1992. MMWR Morb Mortal Wkly Rep 1993; 42: 521-524.
  • 21. Adult lead poisoning from an Asian remedy for menstrual cramps — Connecticut, 1997. MMWR Morb Mortal Wkly Rep 1999; 48: 27-29.

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