Clinical Manifestations and Therapy of Acute Lead Intoxication Due to the Ingestion of Illicitly Distilled Alcohol

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Abstract
Thirty-two episodes of Pb poisoning observed in 27 patients from the ingestion of bootleg whiskey made in Pb-containing pipes and automobile radiators is reported. Seven patients had Pb encephalopathy manifested by delirium, drowsiness, convulsions, and coma associated with increased cerebral spinal fluid protein. Basophilic stippling in both peripheral blood and bone marrow, a hypochromic anemia, increased reticulocytes, and an occasional positive direct Coombs'' test were the major hematologic abnormalities. The gastrointestinal symptoms consisted of anerexia, nausea, vomiting, severe abdominal pain, and severe constipation, mimicking obstruction of the large bowel. These symptoms were of sufficient magnitude to cause surgical intervention in 3 patients in whom the diagnosis was not recognized. Initial albuminuria in 6, of whom 5 had moderate azotemia, cleared during treatment. Indirect bilirubinemia greater than 1 mg % was seen in 7. Treatment with Ca EDTA, either 2 g/day for 5 days, or 1 g/day for 10 days resulted in the alleviation of the abnormal signs and symptoms in all of the patients. On therapy 24-hour urine Pb excretion ranged in individual patients from 1.5 mg to 20 mg/24-hour urine volume. No toxic effects of Ca EDTA therapy were noted in these patients. Ca EDTA therapy of adult patients with Pb poisoning remains an effective and safe therapeutic method.