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Lead poisoning caused by drinking from a green ceramic cup

Lead poisoning caused by drinking from a green ceramic cup

Deutsche Medizinische Wochenschrift 123(12): 353-358, March 20

History and admission findings: A 24-year-old woman, an administrative employee, was admitted with colicky abdominal pain and constipation, as well as breathing-related chest pain of recent onset with cough and sometimes blood-streaked sputum. She had previously been unsuccessfully treated for gastritis and adnexitis. On physical examination revealed diffuse, ill-defined abdominal pain on pressure and mild tachycardia, but was otherwise unremarkable. Investigations: Electrocardiogram, chest radiogram, lung scintigraphy, abdominal sonography, oesophago-gastro-duodenoscopy and gynaecological examination indicated nothing abnormal. Laboratory tests showed microcytic anaemia, slight leucocytosis and anisocytosis, as well as polychromasia and basophilic stipling of erythrocytes. The 24-h urinary porphyrin concentration was elevated. Diagnosis, treatment and course: Precise differentiation of porphyrins in urine, stool and erythrocytes by enzymatic measurement first raised the suspicion of lead poisoning. Whole-blood lead concentration was markedly raised to 600 mug/l (normal up to 90 mug/l) and 170 mug/dl in urine (normal up to 80 mug/dl). A ceramic cup from Greece was traced as the source of the lead, the patients having regularly for over 2 1/2 months drunk lemon instant-tea from it. She was treated with oral doses of DMPS (sodium salt of 2,3-dimercapto-1-propan-sulphonic acid), 5 - 10 mg/kg 3X daily for 2 days, followed by 2.5 mg/kg 2 X daily, until lead concentrations in blood and urine had become normal, when all symptoms disappeared: detoxification was complete within 4 months. Conclusion: This case impressively illustrates how difficult it can be to diagnose lead poisoning and identify its source. Oral DMPS is a practicable and efficacious form of treatment.

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