Death by Lead Poisoning- from swallowing one piece of lead?

[casebro]

This, from many news sites on the net:

"The recalled jewelry contains high levels of lead, posing a risk of lead poisoning and adverse health effects to young children.

Reebok has received a report of a death caused by lead poisoning of a 4-year-old child from Minneapolis, Minnesota. The child reportedly swallowed a piece from one of these bracelets.

The recall involves an 8-inch long metal bracelet with a heart-shaped charm. The name “Reebok” is engraved on the one side of the charm. The charm bracelet was provided as a free gift with the purchase of various styles of children’s footwear."

I suspect the 4 year old choked, since I've only heard of lead poisoning from long term exposure. I can't find any more info on that child. Anybody Minnbesotans familiar with this case? Or any other death from a single exposure?

[Iamme]

Did this news story hit the air waves during the NCAA basketbal playoffs? Because if it did, well, I have been glued to watching basketball lately (hoping for upsets :) )

But I HAVE heard...and I don't know if this is true either...that some very miniscule amount of mercury can contaminate an entire lake and kill off everything, probably including you, if you drank any of the water. I THINK it only requires a very minute amount of mercury in the water....I think.

[Maxwell's Demon]

I had a look on Medline - it seems to indicate that a single large dose can be fatal, but the most common poisoning comes from long term exposure. I'm still a little surprised that an object like the one involved can dissolve so quickly in the digestive tract as to deliver a fatal dose. I would have thought it would be excreted before it could do so.

[Iamme]

Heavy metals don't excrete well. That is why people have to go through rigorous chelation.

[tkingdoll]

Here's the story: http://news.bbc.co.uk/1/hi/business/4840188.stm

And here's the item in question:

http://newsimg.bbc.co.uk/media/images/41482000/jpg/_41482546_bracelet203index_pa.jpg

[Dogdoctor]

Ingested lead metal is gradually oxidized by stomach acid and absorbed. If the metal object stays in the stomach it will lead to lead poisoning and possible death. I have seen a lead poisoning case in a dog who ingested a fishing weight (it survived but was quite sick for a little while). Looking at the time frame it probably ate it about a month earlier.

[Rob Lister]

Heavy metals don't excrete well. That is why people have to go through rigorous chelation.

Iamme, it depends on the form. I too would think that such a small compact object would have been excreted rather than absorbed. Occam's razor suggests the death, if actual, occured by choking.

[tkingdoll]

The article I linked to states that the item was too large to be excreted and so stayed in the stomach and killed the boy, as per Dogdoctor's description.

[Amapola]

They said the jewelry was made in China and contained as much as 99% lead.

Now why in the wide world of sports did they make the jewelry out of lead??! Especially since it was for children........ someone somewhere must surely have known that kids put things in their mouths. Heck, adults do it too. Surely something more innocuous could have been used.

[casebro]

Hmmm, so I guess that the over-scale heads of children also contain oversized gullets? I would think that anything a critter could swallow would pass on through the digestive system, but I guess it's not true of children?

Reminds me of the joke about the monkey in the bar, who swallows the cue ball. Crude joke about a crude monkey.

I'd like to hear about the medical care the kid got. First symptoms? How long before x-ray? But the first 50 google hits had no explanation of the charm getting caught in the stomach, all were copied from the same AP article?

[Dogdoctor]

The way it is arranged you can swallow something larger than should be able to leave your stomach (your stomach is supposed to partially digest it). In dogs and cats there are several areas where ingested objects get hung up. If they are really big they may get stopped in the oral pharyngeal area, a little smaller and they may stick in the esophagus as it passes under the heart and large blood vessels off the heart, a little smaller and it may get hung up at the junction between the esophagus and the stomach, a little smaller and it may stay in the stomach or get lodged at the exit of the stomach, a little smaller and it will become stuck somewhere in the small intestines, a little smaller and it will lodge at the junction between the small intestines and the large intestines. In my experience some heavy objects such as metallic objects may be small enough to pass further but probably due to the weight end up staying in the stomach.

[davefoc]

I wondered about this story also.

The basic idea here is that somebody can die of lead poisoning by swallowing a lead object which has the right shape and size to allow it to be swallowed but not to pass through the digestive system?

Still there are a few questions remaining:
1. Jewelry made of 99% lead? Lead doesn't seem like a particularly good metal for jewelry? Why is somebody making jewelry out of lead?

2. Even if lead is an aesthetically and mechanically acceptable metal for jewelry why would somebody make jewelry out of lead given the widespread knowledge of the dangers of lead?

3. Wouldn't there have been symptoms of lead poisoning that preceded the death? Did the child get taken to the doctor and nobody suspected lead poisoning until after the death had occurred?

[Mojo]

Jewelry made of 99% lead? Lead doesn't seem like a particularly good metal for jewelry? Why is somebody making jewelry out of lead? Lead is cheap.

Presumably their philosopher's stone was on the blink.

[Darat]

Lead is cheap.

Presumably their philosopher's stone was on the blink.

Also it is dense (so the gift will feel more solid), easily worked, readily available - so I can see why a "as cheap as possible gift" order to China could end up being made of lead.

[Amapola]

I wondered about this story also.

The basic idea here is that somebody can die of lead poisoning by swallowing a lead object which has the right shape and size to allow it to be swallowed but not to pass through the digestive system?

Still there are a few questions remaining:
1. Jewelry made of 99% lead? Lead doesn't seem like a particularly good metal for jewelry? Why is somebody making jewelry out of lead?

2. Even if lead is an aesthetically and mechanically acceptable metal for jewelry why would somebody make jewelry out of lead given the widespread knowledge of the dangers of lead?

3. Wouldn't there have been symptoms of lead poisoning that preceded the death? Did the child get taken to the doctor and nobody suspected lead poisoning until after the death had occurred?

As a jeweler, I share your consternation at the use of lead - although of course it is widespread. I always felt it was foolish and only use either sterling silver or 14k (and up) gold. However it IS cheaper to use lead, for one thing because of the low melting temperature for casting. To me the dangers outweigh how cheap the resulting jewelry is.

According to Mr. Amapola and the Emergency Medicine: Companion Handbook they would certainly be on the watch for these 3 things together: vague neurologic or abdominal pain, colic and hemolytic anemia. Apparently those 3 things together would really point to lead poisoning. Hard to say whether it was noticed or not, but there are symptoms that indicate lead poisoning.

[Hardenbergh]

People who work with leaded glass are exposed to lead. Also, people who target practice on shooting ranges.

[Hydrogen Cyanide]

People who work with leaded glass are exposed to lead. ....

The exposure is from sanding the joints to get a good surface to solder on, and then there is the lead content in the solder to be aware of (espially when it is hit with a hot iron)... and it has to be done with good ventilation and AWAY from children.

The risk is known and precautions are taken.

Unfortunately there was no warning on the very cheap charms. Ugh.

[Hardenbergh]

The exposure is from sanding the joints to get a good surface to solder on, and then there is the lead content in the solder to be aware of (espially when it is hit with a hot iron)... and it has to be done with good ventilation and AWAY from children.

The risk is known and precautions are taken.

Unfortunately there was no warning on the very cheap charms. Ugh.

Thanks for explaining. I used to work for the Occupational Health Program in the Bureau of Health and our program kept a database for heavy metal poisoning such as lead, mercury, cadmium, arsenic. We used to mail out information to workers that had been exposed to heavy metals above safe levels.

This is the form we used:

http://www.maine.gov/dhhs/eohp/occhealth/occhealthrpt.pdf

http://www.cdc.gov/niosh/topics/ABLES/ables.html

Maine also has a Childhood Lead Program:

http://www.maine.gov/dhhs/eohp/lead/

[Hydrogen Cyanide]

My understanding is that most heavy metal poisonings in industry is when someone disregards the handling rules. I remember one of my college chemistry professor telling us about a researcher in the department that got too casual with the chemicals and became poisoned with sulphur.

I know about leaded glass because it was a hobby I briefly had before kids. It was one of the many hobbies to go by the wayside when they came along.

And because of kids we've picked up additional hobbies, because one likes to hang around art stores. Lots of the stuff they sell there have warnings on their use. Lots of nasty stuff.

So the lesson here is to watch for lead sources... in your link to the Maine Childhood Lead Program the most common causes are lead in old paint and in soil. So be very careful scraping old paint (I hate think how much I may have inhaled in our first house! Fortunately though we used the paint softener to scrape it away wet)... And the other lesson is to read the handling instructions.

Which is why the charms made with lead without any warning, or thinking about ingesting by young children is just criminal.

[RandFan]

Iamme, it depends on the form. I too would think that such a small compact object would have been excreted rather than absorbed. Occam's razor suggests the death, if actual, occurred by choking.So being shot doesn't really kill you via lead poisoning? :D

[RandFan]

But I HAVE heard...and I don't know if this is true either...that some very miniscule amount of mercury can contaminate an entire lake and kill off everything, probably including you, if you drank any of the water. I THINK it only requires a very minute amount of mercury in the water....I think. I don't know either but I do know that many lakes, tributiaries, streams and fish are contaminated by mercury and haven't died off. How much is minscule?

I don't think you are right but I do believe that mercury contamination is a very reall problem. Here's a really good web site (http://pubs.usgs.gov/fs/fs-016-03/) so you can be informed.

[Dogdoctor]

3. Wouldn't there have been symptoms of lead poisoning that preceded the death? Did the child get taken to the doctor and nobody suspected lead poisoning until after the death had occurred?
Being a dogdoctor I can tell you it is a little difficult to determine without having some index of suspicion because the signs can be caused by many other diseases or medical conditions. In the case of humans here is a link to the signs
Irritability
Loss of appetite
Weight loss
Sluggishness
Abdominal pain
Vomiting
Constipation
Pallor from anemia
http://www.cnn.com/HEALTH/library/FL/00068.html
there they do say it is rare to have death from it but still rare means death does occur and ingesting a lead metal object is not a common way for them to get poisoned.

[Struggler]

I find the claim of 99% lead suspicious. Can you imagine how heavy a crate of 99% lead trinkets would weight? I think the freight charges from China would offset any savings from foreign manufacturing.

Jim

[Iamme]

I don't know either but I do know that many lakes, tributiaries, streams and fish are contaminated by mercury and haven't died off. How much is minscule?

I don't think you are right but I do believe that mercury contamination is a very reall problem. Here's a really good web site (http://pubs.usgs.gov/fs/fs-016-03/) so you can be informed.

I simply heard this once...somewhere. That is the best I can offer. Not good enough, I know. I actually then worried that terrorists reading what I read would simply dump Honeywel thermostats into lakes.and that wuld be that.

Regarding mercury in fish; isn't that into the parts per billion, or no less than millions? So then, what about tablespoon fulls in the water?

[Iamme]

I find the claim of 99% lead suspicious. Can you imagine how heavy a crate of 99% lead trinkets would weight? I think the freight charges from China would offset any savings from foreign manufacturing.

Jim



Did you know that gold is even heavier still? And I think there may be some stuff even heavier than gold.

[Hardenbergh]

I simply heard this once...somewhere. That is the best I can offer. Not good enough, I know. I actually then worried that terrorists reading what I read would simply dump Honeywel thermostats into lakes.and that wuld be that.

Regarding mercury in fish; isn't that into the parts per billion, or no less than millions? So then, what about tablespoon fulls in the water?

Here are some links about mercury in fish:

http://www.maine.gov/dhhs/eohp/fish/ (Main Page)

http://www.maine.gov/dhhs/eohp/fish/hgchart.pdf

http://www.maine.gov/dhhs/eohp/fish/fishbroch.pdf

http://www.maine.gov/dhhs/eohp/fish/2KFCA.shtml

http://www.maine.gov/dhhs/eohp/fish/saltwater.shtml

[Iamme]

Or this:

http://www.epa.gov/economics/children/body_burdens/b4.htm

[SteveGrenard]

or this:

http://www.medpagetoday.com/InfectiousDisease/PublicHealth/dh/2966

[Starthinker]

Wasn't this on 60 Minutes or some such? Seems the jewelry in question is from gumball machines and it was the venders that took much of the heat for putting such things in gumball machines to begin with. After all, what adult gets their jewelry from a gumball machine?

[richardm]

Seems the jewelry in question is from gumball machines

I think you must be thinking of something else, since both the opening post and TKs link explicitly state that the jewellery was given away free with children's footwear made by Reebok.

[Skeptic Ginger]

Rob Lister: "I too would think that such a small compact object would have been excreted rather than absorbed. Occam's razor suggests the death, if actual, occured by choking."

Struggler: "I find the claim of 99% lead suspicious. Can you imagine how heavy a crate of 99% lead trinkets would weight? I think the freight charges from China would offset any savings from foreign manufacturing."

davefoc: " Still there are a few questions remaining:
1. Jewelry made of 99% lead? Lead doesn't seem like a particularly good metal for jewelry? Why is somebody making jewelry out of lead?

2. Even if lead is an aesthetically and mechanically acceptable metal for jewelry why would somebody make jewelry out of lead given the widespread knowledge of the dangers of lead?

3. Wouldn't there have been symptoms of lead poisoning that preceded the death? Did the child get taken to the doctor and nobody suspected lead poisoning until after the death had occurred?"

casebro: "I suspect the 4 year old choked, since I've only heard of lead poisoning from long term exposure. I can't find any more info on that child. Anybody Minnbesotans familiar with this case? Or any other death from a single exposure?

I'd like to hear about the medical care the kid got. First symptoms? How long before x-ray? But the first 50 google hits had no explanation of the charm getting caught in the stomach, all were copied from the same AP article?"

The following from SteveG's cited article answers all these questions. The child, who had a history of microcephaly and delayed development, was brought to a hospital pediatric emergency department with a complaint of vomiting. Doctors there diagnosed probable viral gastroenteritis and administered Zofran (ondansetron) and sent home with instructions to parents to monitor fluid intake.

He returned two days later with intractable vomiting, poor oral intake, sore "tummy" and listlessness. At that time he was dehydrated, with normal blood sodium but elevated blood urea nitrogen levels. He was admitted to the hospital and IV fluid replacement was initiated.

The child's condition deteriorated, and 10 hours after admission he suffered respiratory arrest while being transported to the radiology department. He was resuscitated and placed on mechanical ventilation.

Imaging studies included CT of his head and chest and radiographs of his abdomen. The CT revealed diffuse cerebral edema, which was treated with emergent ventriculostomy and decompressive craniotomy.

The x-rays revealed a heart-shaped object that was initially mistaken for a radioplaque temperature probe. When additional review correctly identified the object as foreign object in his stomach, testing for heavy metals was requested.

The following day a blood lead level of 180 μg/dL -- almost twice the life-threatening level of lead -- was reported. There was no evidence of blood flow to the brain, and the boy met criteria for clinical brain death. On the fourth day of hospitalization life support was removed.

The child's mother, who didn't know he had swallowed the charm, said it came with a pair of shoes belonging to a child whose home her son had visited.

Following the death, a staff member with the Minneapolis Department of Regulatory Services obtained two similar charms -- one with a pair of shoes purchase at a local shoe store and the second from a pair of shoes purchased from the Reebok website. The charm from the shoe store was 67% lead content by weight while the charm from the shoes purchased online tested at 0.07% by weight.

In Atlanta, the CDC obtained four charms from shoes purchased at different outlets. When tested, the lead content of those charms ranged from 0.004% by weight to 0.044% by weight.

The variation in lead content, according to the CDC, is "consistent with previous test results for small, inexpensive metallic jewelry."