Is lead poisoning in children a real concern ? and homoeopthic approach

Dr Sakshi.  

Abstract:
The prevalence of asymptomatic lead poisoning in children has increased, children younger than 5years old, low socioeconomic position, residing in a home constructed prior to 1978 and consuming imported food, medications and pottery are risk factors for lead poisoning. Using primary prevention measure is crucial to removing leads detrimental effects on a child’s development. It has been regularly shown that children with blood lead levels of 5μg/Dl, or less, who appear asymptomatic have poor neurocognitive and behavioural development. In order to detect lead poisoning in children exposed to lead in the environment, healthcare providers should do focused screening.

Key words: lead poison importance, risk factors, toxicity

Introduction
One of the most prevalent disease of  infancy that are caused by environment is lead poisoning. Lead poisoning makes about 0.6% of the worlds illness burden, but the incidence rate pattern and source of lead exposure vary from nation to nation. In a cross-sectional research conducted in the community 67% of Indian children had elevated lead levels. Lead level increasing by 10μg/dL in blood causes poisoning. When necessary laboratory tests, iron supplements for children with iron deficiency and chelation therapy for blood lead level 45μg/dL or more are recommended. Education and avoiding items contaminated with lead are the two main components of prevention.

Incidence:
lead poison occurs due to ingestion of water from lead pipes, food containers, paints and insecticides and from inhalation through ambient air pollution from leaded petrol, battery storage, crystal glasses, ceramic glazes, enamel jewellery, plastic and rubber stabilisers, surma and vermillion. When the level of lead in blood increases by 10μg/dL. There is progressive involvement of Gi, peripheral nerves, haematological and CNS. According to a study on lead levels in metropolitan areas, 4.5% of children had lead levels higher than 10μg/Dl, although non of them showed any symptoms.

Aetiopathogenesis:
A child may be exposed to lead by inhalation, ingestion and contact through skin. Exposure during intrauterine life can be more harmful. Fact that early life exposure may reprogram genes and change their expressions. Children who consumes inedible items may get chronic lead toxicity, which presents as resistant anemia and abdominal pain.

Exposure to lead:

By ingestion:- -lead pipes -lead cans -lead toys contaminated food

By contact:- -cosmetic

By Inhalation:- -burning of waste -industrial activity -leaded paints Lead gasoline

Lead causes toxicity by inhibiting the aminolevulinic acid and ferrochelatase enzymes of the heme biosynthesis pathway. Lead mimic as calcium, interfering with calcium homeostasis, disturbing cell signalling pathway. Lead affects all neurotransmitters, but it especially affects the glutamatergic, cholinergic and dopaminergic system. There is a wide range of toxicity associated with lead in children. All systems could be impacted, but the primary organ systems that would be impacted are the central and peripheral nerve systems.

Clinical features:
Acute high dosage exposure to lead is the primary cause of acute lead toxicity, it presents as- colic, pallor, poor concentration, fatigability and constipation. Severe cases mat present with ataxia, seizures/coma. wrist and foot drop, many children who survive have neurological after affects. Chronic toxicity presents as- resistant anaemia, hyperaemia and gout, HTN, peripheral artery disease & impaired immune system and reproductive function. Children may presents with poor school performance, hearing difficulty, difficulty in sleeping and slowed growth.

Management:
Compared to acute toxicity, chronic toxicity is more prevalent yet more challenging to diagnose. Management has to focus on primary prevention. Counselling may given to parents about exposure sources, in prenatal period itself. Well-balanced diet during antenatal period, diet must contain adequate amount of iron, calcium and vit -C, which prevent specific absorption of lead. Eliminating lead pollution from the environment is only long-term effective treatment for lead poisoning. The most crucial tactic in treating childhood lead poisoning is primary prevention of lead exposure. The child’s physician might advise a lead level test for the child during regular checkups. A good primary preventive strategy should concentrate on the two principal sources of lead exposure for kids -1.Lead in housing

2.non-essential uses of lead in specific products like toys, eating and drinking utensils and cosmetics both imported and domestics.

Homoeopathic approach:

Symptomatic treatment: Remedies may be prescribed to address specific symptoms like abdominal pain, constipation, headaches, or neurological issues.

For acute poisoning soluble alkaline find earthy sulphates, especially sulphate of magnesia in milk with eggs, after having induced free vomiting with warm water or sulphate of zinc.

For chronic sulphur baths and kali iod. 5 grains a day can be given.

For the lead colic epsom salt will always first choice of remedy for it’s prevention and care letter we can try other homoeopathic remedies like- Alum, Ars, Bell, Nuv vom, Op, Plat, Pod.

If we see the repertory part,

Toxicity” in Murphy’s Repertory is a very useful chapter because almost all rubrics related with toxicity can be seen here in one place.

Rubrics related with alcohol, drugs, chemicals, poisons, tobacco & vaccinations are included in Toxicity Chapter.

For the lead poisoning we can see the chapter toxicity and Rubric like,

-LEAD, poisoning: ALUM, CAUST, PLB, TUB.

Indication of homoeopathic remedies in lead poisoning

1.Plumbem met:

• -Very violent pains in stomach
• -Constrictive cramps in stomach.
• -Shootings from pit of stomach into back.
• -Cuttings and burning pain in stomach
• -Inflammation of stomach.
• -Weakness or loss of memory.
• -Slow of perception

2.Causticum:

• -Weakness or loss of memory
• -Slow of perception
• -Confusion
• -Unable to think
• -Temporary paralysis
• -dull pain in the ears with constant whizzing, difficult speech, neuralgia of the left face

3.Aluminua:

• -Variable mood
• -confusion
• -Dryness of mucus membrane and skin
• -Bad odor from mouth.
• -Teeth covered with sordes.
• -Gums sore, bleeding.
• -Tensive pain in articulation of jaw when opening mouth or chewing.
• – Colic, like painter’s colic

4.Tuberculinum:

• -Indifferent, forgetful
• -Trembling of hands
• -Inflammation of gums, breath offensive
• -Nausea with efforts to vomit with colic and diarrhoea
• -constriction of abdomen, deep pain
• -excessive fatigue
• -Feeling well, but decidedly losing flesh

5.Nux vomica:

• -Very irritable
• -Gums swollen, white and bleeds
• -Nausea in the morning, weight and pain in stomach
• -Flatulent distension, with spasmodic colic. Colic from uncovering

Conclusion:
Lead exposure can happen from old lead-based deteriorated house paint and dust and soil contaminated with lead such as from leaded gasoline, lead electrode plates from old automobiles batteries, adulterated food, folk remedies and broken lead typesets scattered around old printing establishments.

The identification of neonate, infant/child who has been exposed to lead must be viewed as a public health emergency. Close follow-up care is required for all children.

Reference:

1. BHAT, S. R. (2022). Achar’s Textbook of Pediatrics. India: Orient Blackswan Pvt Limited.
2. Gupta, P., Menon, P., Ramji, S., Lodha, R. (2015). PG Textbook of Pediatrics: Volume 3: Systemic Disorders and Social Pediatrics. India: Jaypee Brothers Medical Publishers Pvt. Limited.
3. Parthasarathy, A. (2016). IAP Textbook of Pediatrics. India: Jaypee Brothers Medical Publishers Pvt. Limited.
4. Mayans L. Lead Poisoning in Children. Am Fam Physician. 2019 Jul 1;100(1):24-30. PMID: 31259498.
5. Warniment C, Tsang K, Galazka SS. Lead poisoning in children. Am Fam Physician. 2010 Mar 15;81(6):751-7. PMID: 20229974.
6.  Homoeopathic medical Repertory by Robin Murphy
7. Homoeopathic therapeutics By Samuel Lilienthal, M.D.
8. Homoeopathic materia medica By William Boericke,M.D.

Dr Sakshi.
PG Scholar, Department of Pediatrics, Father Muller Homoeopathic Medical College and Hospital Deralakatte Mangaluru.
Under the guidance of Prof. Dr Jyoshna Shivaprasad HOD, Pediatrics