title: Infantile lead poisoning from an Asian tongue powder: a case report & subsequent public health inquiry.
abstract: BACKGROUND
  Lead poisoning from novel environmental sources continues to present a challenge to clinicians who treat infants and children.
  
  
  METHODS
  A 12 month old infant of Thai parents was found during well child care to have a venous blood lead concentration of 61 mcg/dL. He was hospitalized for parenteral chelation with CaNa2EDTA and subsequently managed as an outpatient with oral succimer, with a reduction in blood lead concentration to 23 mcg/dL. Chronic lead poisoning was attributed to the use of a Thai tongue powder by the parents for the first seven months of the infant's life. This ethnic remedy was applied to the tongue to absorb toxins, reduce white patches present after milk feedings, and preserve the infant's health.
  
  
  METHODS
  Lead contaminated the powder at 109,000 ppm as measured by x-ray fluorescence spectrometry. Two poison centers in Thailand were contacted and initiated a public health inquiry with the Thai Food & Drug Administration (Thai FDA) to remove contaminated products from the marketplace. Their investigation found six additional contaminated tongue powders (of 10 tested) in a Bangkok shop offering Chinese remedies, some with lead levels > 9000 ppm. These products, unregistered with the Thai FDA, were confiscated and the shop closed. Local media attention and case-finding activities of health officials identified one additional infant suffering from lead poisoning due to tongue powders.
  
  
  CONCLUSIONS
  Asian tongue powders can be a source of lead poisoning. Medical toxicologists, poison centers, and public health agencies can work together internationally to accomplish effective post-marketing product surveillance.
authors.affiliation: Department of Medicine, Children's Hospital, Boston, Massachusetts 02115, USA. Alan.Woolf@childrens.harvard.edu
authors.forename: Alan D
authors.initials: AD
authors.lastname: Woolf
authors.forename: Javed
authors.initials: J
authors.lastname: Hussain
authors.forename: Laura
authors.initials: L
authors.lastname: McCullough
authors.forename: Milena
authors.initials: M
authors.lastname: Petranovic
authors.forename: Chulathida
authors.initials: C
authors.lastname: Chomchai
mesh_terms: D002614:Chelating Agents / Q000627:therapeutic use; D004340:Drug Contamination; D004492:Edetic Acid / Q000627:therapeutic use; D005453:Fluorescence; D006801:Humans; D007223:Infant; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000209:etiology*; D008297:Male; D008518:Medicine, East Asian Traditional; D028321:Plant Preparations / Q000009:adverse effects* / Q000592:standards; D013052:Spectrometry, X-Ray Emission / Q000379:methods; D004113:Succimer / Q000627:therapeutic use; D013785:Thailand; D014059:Tongue
chemical_list: D002614:Chelating Agents; D028321:Plant Preparations; D007854:Lead; D004492:Edetic Acid; D004113:Succimer