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