Plumbism from airborne lead in a firing range. An unusual exposure to a toxic heavy meta

Karl Anderson, Alf Fischbein, David Kestenbaum, Shigeru Sassa, Alvito P. Alvares, Attallah Kappas

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Plumbism developed in a 17 year old boy while he was working in an indoor firing range. Diagnosis was delayed because a blood lead level was initially reported to be within normal limits and because acute intermittent porphyria was suspected. Subsequently, lead poisoning was clearly documented by characteristic abnormalities of the heme biosynthetic pathway in erythrocytes (inhibited δ-aminolevulinic acid dehydratase activity, increased protoporphyrin-IX), increased urinary excretion of δ-aminolevulinic acid and coproporphyrin, and elevated levels of lead in blood and urine. These abnormalities as well as decreased nerve conduction velocity and reduced hepatic cytochrome P-450 function, as assessed by metabolism of antipyrine, returned towards normal with chelation therapy. Investigation of the firing range showed airborne lead to be markedly increased during firing; a co-worker was also found to have asymptomatic lead poisoning. This experience shows that exposure to heavy metals can occur by mechanisms which are unusual and not widely recognized, and illustrates the importance of testing erythrocytes and urine for distinct biochemical abnormalities related to the heme synthetic pathway when differentiating hereditary hepatic porphyria from plumbism.

Original languageEnglish (US)
Pages (from-to)306-312
Number of pages7
JournalThe American Journal of Medicine
Volume63
Issue number2
DOIs
StatePublished - 1977
Externally publishedYes

Fingerprint

Lead Poisoning
Poisons
Heme
Hepatic Porphyria
Erythrocytes
Coproporphyrins
Urine
Porphobilinogen Synthase
Chelation Therapy
Acute Intermittent Porphyria
Antipyrine
Aminolevulinic Acid
Delayed Diagnosis
Neural Conduction
Biosynthetic Pathways
Heavy Metals
Cytochrome P-450 Enzyme System
Liver
Lead
protoporphyrin IX

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Plumbism from airborne lead in a firing range. An unusual exposure to a toxic heavy meta. / Anderson, Karl; Fischbein, Alf; Kestenbaum, David; Sassa, Shigeru; Alvares, Alvito P.; Kappas, Attallah.

In: The American Journal of Medicine, Vol. 63, No. 2, 1977, p. 306-312.

Research output: Contribution to journalArticle

Anderson, Karl ; Fischbein, Alf ; Kestenbaum, David ; Sassa, Shigeru ; Alvares, Alvito P. ; Kappas, Attallah. / Plumbism from airborne lead in a firing range. An unusual exposure to a toxic heavy meta. In: The American Journal of Medicine. 1977 ; Vol. 63, No. 2. pp. 306-312.
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