Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 5, Number 4, April 2014, pages 187-193

Lead Intoxication Treated With D-Penicillamine


Figure 1.
Figure 1. (A) Abdominal X-ray on admission showed retention of feces suggesting constipation. There were no other abnormalities despite severe abdominal pain. (B) Blood smear on admission showed basophilic stippling in erythrocytes, leading to a suspicion of lead intoxication (original magnification × 400).
Figure 2.
Figure 2. Daily urinary lead excretion (rectangles) and δ-aminolevulinic acid (δ-ALA) concentration in spot urine samples (triangles). The δ-ALA concentration peaked on day 2. Lead excretion increased significantly after administration of D-penicillamine, peaking on day 3. Both parameters gradually decreased after the peak.


Table 1. Laboratory Findings on Admission
*These values are outside the normal ranges. MCV: mean corpuscular volume; MCH: mean corpuscular hemoglobin; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; ALP: alkaline phosphatase; g-GTP: gamma-glutamyltranspeptidase; CPK: creatine phosphokinase; UIBC: unsaturated iron binding capacity.
  Red blood cells*268 × 104/mm3
  Hemoglobin*8.1 g/dL
  MCV88.4 fL
  MCH30.2 pg
  White blood cells6,900/mm3
  Platelets28.5 × 104/mm3
  Total protein7.2 g/dL
  Albumin5.0 g/dL
  AST32 IU/L
  ALT*74 IU/L
  LDH196 IU/L
  ALP217 IU/L
  g-GTP38 IU/L
  Total bilirubin*2.4 mg/dL
  Direct bilirubin0.2 mg/dL
  Choline esterase238 IU/L
  CPK120 IU/L
Amylase106 IU/L
Total cholesterol158 mg/dL
Blood urea nitrogen*26.6 mg/dL
Creatinine0.74 mg/dL
Uric acid3.5 mg/dL
Sodium*134 mEq/L
Potassium4.5 mEq/L
Chloride101 mEq/L
Glucose108 mg/dL
Iron157 mg/dL
UIBC*74 mg/dL
Ferritin*341 ng/mL
Haptoglobin121 mg/dL


Table 2. Reported Adult Patients with Acute-Onset Symptoms of Lead Intoxication
CaseAuthorAge, sex, occupationExposure periodIllness periodSymptomsBlood lead level (µg/dL)Hb (g/dL)Chelation therapy
M: male; F: female; Hb: hemoglobin; EDTA: intravenous calcium-ethylenediaminetetraacetic acid; DMSA: oral meso-2,3-dimercaptosuccinic acid.
1Ziegler [14]16, F, unknownUnknown6 monthsAbdominal pain, weight loss91.99.2EDTA
2Bennett [8]40, M, painterUnknown6 weeksAbdominal pain, malaise, arthralgia, mental impairment87.19.4EDTA
3Bennett [8]51, M, decoratorUnknown4 weeksHeadache, nausea, dizziness, constipation, hand weakness84.213.2EDTA
4Bennett [8]22, M, painterUnknown2 weeksAbdominal pain, malaise, nausea, headache85.29.7EDTA
5Ogawa [17]34, M, painter1 monthUnknownAbdominal pain73.110.5EDTA
6Ogawa [17]30, M, painter2 months2 monthsChest, back and abdominal pain, nausea96.312.4EDTA
7Dounias [18]33, F, battery worker3 months2 weeksAbdominal pain, malaise90.08.0DMSA
8Barber [5]26, M, unknownUnknown2 weeksAbdominal pain, vomiting, erratic behavior157.8Unknown(-)
9Verheiji [19]40, M, unknownUnknownA few weeksAbdominal pain86.09.2EDTA
10Shamshirsaz [20]Unknown, F, unknownUnknown9 daysAbdominal pain, diarrhea, loss of appetite102.09.3DMSA