Departments of Pediatrics.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Pediatrics. 2024 Oct 1;154(Suppl 2). doi: 10.1542/peds.2024-067808J.
We summarize here the presentation and course of lead poisoning in a 1-year-old who ingested a lead-containing metallic medallion from India. We analyzed the medallion to determine its composition, using x-ray fluorescence spectroscopy and field emission scanning electron microscopy. A simple extraction test was used to estimate oral bioavailability. We used the US Environmental Protection Agency Integrated Exposure Uptake Biokinetic model to compare actual versus predicted blood lead levels. X-ray fluorescence analysis revealed the composition of the medallion to be: Lead 155 000 ppm (15%), copper 530 000 ppm (53%), nickel 49 000 ppm (4.9%), arsenic 22 000 ppm (2.2%), antimony 12 000 ppm (1.2%), tin 3000 ppm (0.3%), and silver 1300 ppm (0.13%). With a fixed ingestion of 7786 µg/d (estimated by simulated gastric extraction analysis) and assuming 50% bioavailability, Integrated Exposure Uptake Biokinetic modeling predicted the geometric mean blood lead level would increase from 2.05 µg/dL to 173.9 µg/dL. This patient had potentially life-threatening lead poisoning from an ingested piece of jewelry. The medallion contained 550 times the allowable content of lead in children's metallic jewelry sold in the United States. This case highlights the ubiquitous nature of lead in our global environment and the risk of exposure to novel sources, especially for children.
我们总结了 1 岁患儿因吞食来自印度的含铅金属奖章而导致铅中毒的临床表现和过程。我们使用 X 射线荧光光谱法和场发射扫描电子显微镜分析了奖章的组成。采用简单的萃取试验来估计口服生物利用度。我们使用美国环境保护署综合暴露摄入生物动力学模型比较了实际与预测的血铅水平。X 射线荧光分析表明，奖章的组成如下：铅 155000ppm（15%）、铜 530000ppm（53%）、镍 49000ppm（4.9%）、砷 22000ppm（2.2%）、锑 12000ppm（1.2%）、锡 3000ppm（0.3%）和银 1300ppm（0.13%）。通过模拟胃液提取分析，我们估计患儿的固定摄入量为 7786µg/d，假设生物利用率为 50%，综合暴露摄入生物动力学模型预测血铅水平的几何平均值将从 2.05µg/dL 增加到 173.9µg/dL。该患儿因吞食一件首饰而发生了潜在危及生命的铅中毒。该奖章中的铅含量是美国销售的儿童金属首饰允许含量的 550 倍。本病例突出了铅在我们全球环境中的普遍存在以及接触新型来源的风险，尤其是对儿童而言。
