Lead, and the Children of Flint

Toddler-Playing-With-A-Chair-01In April of 2014 politicians in Flint, Michigan changed the city’s water supply from Lake Huron and the Detroit River to the Flint River, in order to save money. The water from the Flint River was more acidic and had more salt and chlorine in it, and it corroded the aging lead pipes through which it flowed, allowing lead into the water and poisoning the inhabitants of Flint.

The EPA allows 15 ppm (parts per million) of lead in drinking water. Water from homes in Flint tested as high as 13.2 thousand ppm. Lead levels in children’s blood doubled, then doubled again.

Nontombi Naomi Tutu said we “needed the people of Flint to remind the people of this country what happens when political expediency, when financial concerns, overshadow justice and humanity.”

Why do we worry about Lead?

Lead is a soft gray heavy metal that functions in our bodies as a neurotoxin–it poisons nerves. Acute lead poisoning causes headaches, stomach pain, clumsiness, agitation or drowsiness, convulsions and death.

Chronic lead poisoning is more insidious. Lead is most harmful to infants, children and pregnant woman, because it damages developing nerves. Kids who are poorly nourished will be more affected because deficiencies in iron, calcium and zinc increase their body’s absorption of lead. Babies are more at risk because they live closer to floors and surfaces and everything goes into their mouths. Exposed children:

  • can lose cognitive function and develop speech and reading problems.
  • can be unable to focus and organize their thoughts, and exhibit behavior problems.
  • have a higher school dropout rate, problems with aggression, and a higher rate of delinquency.
  • can have damage to their hearing.
  • will have problems growing because lead messes with their ability to use Vitamin D and iron.
  • become anemic, which leaves them less able to transport oxygen around their bodies.
  • can cause damage to their kidneys, giving them lifelong problems with hypertension and cardiovascular disease.

Where is lead found?

When I was a kid we wrote with lead pencils and had lead in our gasoline!

Nowadays, lead is used in some industries, found in deteriorating lead paint in old houses, and leached out of old lead water pipes and pipes with lead solder. We also occasionally run into it in old toys, old Christmas decorations, and jewelry, and in toys, ceramics and cans imported from other countries. Cosmetics such as surma and kohl can have lead, as can some home remedies and dietary supplements. A few years ago there were crayons with lead in them. The manufacturer said, “Kids weren’t supposed to eat them!”

Ideally, we prevent lead poisoning.

  • If you work in an industry that uses lead, take off your shoes when you enter your home.
  • Don’t give your kids old toys and jewelry to chew on.
  • If you have lead pipes in your home, run the water for 30 seconds before you use any of it to drink or cook, because lead will gradually leach from the pipes it is sitting in. Never drink or cook with water run hot from the tap–hot water leaches out more lead.
  • If you live in an old house, clean up peeling paint and household dust with a wet mop.
  • Check for lead paint before any home renovations.
  • If you have well water, test it for lead. Most well filters do remove lead.
  • Give your child a nutritious diet to avoid deficiencies in iron, calcium, and zinc.

Treatment for Lead Poisoning:

Pediatricians generally check children’s lead levels at 12 months and sometimes 2 years, and any time there is concern.

Treatment of lead poisoning varies with how high the level is.

Between 5 and 45 mcg/dl, treatment involves finding and eliminating the source and optimizing the child’s nutrition. Levels as low as 5 mcg/dl have been shown to have lasting effects on children, but chelation therapy at these levels has not been proven to have any effect on kids’ cognitive ability or behavior.

Kids with levels over 45 mcg/dl need to be treated with chelating agents, which can be quite dangerous. Chelators bind the metal in the blood and improve its excretion into urine and stool. Unfortunately chelators also bind minerals that your child’s body needs for normal growth and development. Also, kids can be allergic to the chelators, and the medicine can damage their liver or kidneys.

Far better to prevent the exposure.

I do not have words for how horribly the people of Flint were betrayed by their elected officials.

Some resources if you have concerns:

  • EPA Safe Drinking Water Hotline  800-426-4791
  • Poison Control 800-222-1222
  • Pediatric Environmental Health Specialty Unit Network (PEHSU) 888-347-2632

 

Domesticated Momster

Top Ten Holiday Poisonings

Cute kid girl in glasses thinking about gift on Christmas holiday. Vintage portrait

or, “how to avoid visiting the Doc during the Holidays”:

  1. Tiny magnets: These aren’t really poisonous but they can get stuck in noses and ears, choked on or swallowed. Keep track of the big kid’s toys so I don’t have to make the little one cry digging something out of his or her ear. Worse, magnets that are choked on or swallowed can require surgery to remove. Two magnets in the gut will stick to each other and wear through the bowel wall.
  2. Button batteries: Same problems as above, plus they can leak and cause burns, eating holes through the bowel that can be fatal.
  3. Grandma’s meds: These are on countertop at her home, and sitting in her unattended purse when she is visiting yours. This is the most common poisoning that I see. Other people’s meds also count, of course.
  4. Household poisons: Both the usual suspects (cleaning products, bug sprays) and the holiday specific (liquid fuels) are more available and less monitored in the holiday craziness. Lock ’em up.
  5. Food: Avoid potato salad that was made on the counter where they just cleaned the chicken. Return leftover food to the refrigrerator quickly. Wash those hands! Pick up and throw out unfinished drinks–kids can drop their blood sugar and fall into a coma with a relatively small amount of alcohol. Throw away cigarette butts, because kids eat them and the poisons in cigarettes can actually throw small people into a seizure. (And we inhale these things on purpose. Blech.) Add e-cigarette refills to this list for the last couple of years. 1/2 tsp can kill a child.
  6. Decorations: It’s actually pretty hard to poison anybody with holiday décor. Antique items will sometimes have lead, so don’t let the little guy eat the metalics. Don’t breath in the spray snow, because it has either acetone or methylene chloride in it. And don’t hit Uncle Joe with that branch, no matter how tempting….
  7. Plants: Poinsettias are not poisonous. Promise. Neither is Christmas cactus. Holly berries, mistletoe berries and peace lily berries are, as are bittersweet and boxwood.
  8. Smoke and carbon monoxide: Very poisonous. Live trees and decorations can be dry and fires, candles and space heaters abound. Keep your eyes open and your smoke and carbon monoxide detector batteries fresh.
  9. Mind numbing toys: Boycott toys that don’t engage your children’s minds. Look for toys that they can create with, explore with, or build with. I know this is not strictly a poison, but it’s my list, so I can bend the rules. So,…
  10. Poisonous soul numbing holiday insanity: Back up and take a breath before you spend money you don’t have on stuff you don’t need. Defeat stress and exhaustion with a healthy diet, exercise and regular sleep. Celebrate your heritage, enjoy your family and friends and create joyful memories. Ditch the rest.

How to Prevent Carbon Monoxide Poisoning

Okay, I tried, but there is just no way to make carbon monoxide interesting. Read it anyway, because it’s good for you: you need to know this stuff. Like eating your vegetables. Every one of us encounters carbon monoxide on an almost daily basis, because it is ubiquitous and sneaky. We need to know where it comes from, how to avoid it, the symptoms it causes, and what to do if we or our children are exposed.

Carbon monoxide (CO: one carbon, one oxygen) is a colorless, odorless, tasteless, and initially nonirritating gas produced largely by partial oxygenation of carbon based fuels. Complete oxygenation would produce carbon dioxide (CO2), which we exhale every time we breathe. Plants use that to make us more oxygen.

CO can accumulate in poorly ventilated, enclosed areas. When we breathe in large amounts, the CO binds with the hemoglobin in our blood and forms carboxyhemoglobin. Carboxyhemoglobin circulates through our bloodstreams like the regular stuff, but it does not like to release its oxygen to our brains, hearts, muscles, and organs. We suffocate while still breathing the air around us.

Aristotle, who lived around 300 BC, was the first person to note that coal fumes led to “a heavy head and death.” In ancient times, it was one way criminals were killed: they were locked in a small room with smoldering coals.

It is thought that CO is to blame for some haunted houses: its accumulation can cause hallucinations, disorientation, and delirium.

Oddly, a little CO can be a good thing: it is an anti-inflammatory, encourages growth of nerves and blood vessels, communicates between nerves, and may have some function in long term memory. Very little. Don’t go looking for it.

Statistics on CO poisoning vary significantly with who’s reporting them. It is considered to be the leading cause of poisoning injury and death worldwide. Poison help lines in the US report about 15,000 calls a year, with an estimated 70 deaths. Approximately 40,000 people seek medical care for exposures, and CO accounts for around 15,000 ER visits each year. The CDC estimates more than 500 deaths per year overall in the US, with the largest percentage being in the under 5 age group. More poisonings occur in the winter (gas heaters) and after disasters (generators).

CO is created by burning carbon-based fuels (wood, gasoline, diesel, propane, kerosene, lamp oil), by smoking (tobacco is a carbon based fuel), and by exposure to methylene chloride (degreasers, solvents, paint removers). Don’t smoke (so many reasons), and use degreasers, solvents and paint removers only in well-ventilated areas. Appliances that can produce CO need to be maintained, inspected annually, and well ventilated. Some of the most common ones are:

  • Forced air furnaces
  • Wood stoves/fireplaces (open that flume!)
  • Space heaters (non-electric)
  • Gas water heaters
  • Gas stoves
  • Gas dryers
  • Anything with a pilot light
  • Barbecues, Hibachis
  • Automobiles (never run them in an enclosed space!)
  • Generators
  • Fuel powered tools (if you put gas in it, don’t use it indoors)
  • Boats (don’t use those indoors either)

Symptoms of acute (not chronic) CO poisoning include effects on the brain (dizziness, headache, confusion, lethargy, drowsiness, irritability, irrational behavior), lungs (shortness of breath) and heart (palpitations, paleness). If exposure continues, loss of consciousness and death will follow.

Chronic exposure to lower levels of CO can result in headaches, depression, confusion, memory loss, nausea, and permanent neurologic damage.

Pregnant women, fetuses, and children are especially sensitive. As with most poisonings, children’s small bodies are more sensitive, their higher metabolic rate brings it into their bodies more quickly, and they don’t have the ability to escape.

People with lung, blood, or heart disease, like asthma or anemia, are also more susceptible.

Of note is that CO damage from methylene chloride can last twice as long as that from burning carbon based fuels, because it is stored in our tissues.

Overall, it is a good idea to prevent any exposure to CO. Maintain and inspect those appliances, and make sure they are vented. Open the flume when you have a fire in the winter. Never barbecue or use a hibachi indoors. Throw out the cigarettes, because people who smoke have levels of CO in their blood streams several times higher than non-smokers. Perhaps most important, since you can’t smell this stuff, install CO detectors near every area where people sleep. Many newer fire alarms contain CO detectors, making this even more convenient.

If you are exposed, go outside into clean air. If you are having any symptoms (light-headedness, shortness of breath, seeing ghosts…) seek medical attention. They will give you oxygen and monitor your heart and brain.

Yay! You made it through, even the dreaded chemistry. Not as bad as you thought, right? Knowledge rules!