Cases presentation
A family of five visited the lead poisoning clinic complaining of mostly fatigue and exhaustion. They were accidentally using swamp stone powder for over five months instead of Cinnamon in their food. Their demographic information is further explained in table one. All 5 cases present with the chief complaint of recurrent colicky abdominal pain and fatigue. Gastrointestinal upset (abdominal pain, nausea, and diarrhea) was seen in all 5 cases. Case 1 and 2 (both parents) were experiencing severe paresthesia in the upper and lower extremities. Case 2 (mother) had significantly severe loss of appetite associated with significant weight loss (more than 10% in recent three months), bilateral pitting edema in legs without renal impairment with normal thyroid function test and normal serum protein and albumin, unusual taste, joint and generalized muscles pain, weakness, and paresthesia due to consumption of more amounts of swamp stone powder as Sinnamon in her herbal tea by mistake [table 2]. She also was anemic (hypochromic-microcytic).
Case 3 was complaining of shortness of breath and dyspnea as the initial symptom. The mother and the middle child complained of a depressed mood. Loss of appetite and weight loss was the most prominent complaint of the father. The mother and oldest daughter had joint pain, especially in their wrist. Their son had some macular red skin color changes on his hand and foot. Discoloration of gum, memory loss, seizure, constipation, and kidney dysfunction were not detected in any of them. The result of the initial blood lead level is available in table one. The summary of their signs and symptoms is explained in table 2. Although some symptoms such as abdominal pain, diarrhea, nausea, and muscle weakness were common and saw in all patients, other symptoms and signs had variability.
They all were admitted to the hospital to receive chelation therapy. All four adult family members were treated with intravenous Ethylenediamine tetra acetic acid (CaNa2 EDTA), two grams for three days. The youngest child received one gram (25mg/kg/day) of EDTA for three days. During their admission, daily calcium was tested, and the patients received daily doses of calcium supplements. Their thyroid hormone levels were tested, and the results came back normal. The Electromyography (EMG) and nerve conduction velocity (NCV) were normal in all five family members, and no signs of peripheral neuropathy were detected, despite experiencing paresthesia in all cases.
After completing the first chelation therapy session with intravenous CaNa2 EDTA, their well-being improved, but some symptoms such as finger numbness, generalized weakness, and muscle pain remained. The blood lead level (BLL) changes after therapy have been shown in table 1. We followed them with checking BLL two weeks after discharge.
Table 1: Demographic variables and level of blood lead