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Toxicants in folk remedies: implications of elevated blood lead in an American-born infant due to imported diaper powder

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Abstract

Though most childhood lead exposure in the USA results from ingestion of lead-based paint dust, non-paint sources are increasingly implicated. We present interdisciplinary findings from and policy implications of a case of elevated blood lead (13–18 mcg/dL, reference level <5 mcg/dL) in a 9-month-old infant, linked to a non-commercial Malaysian folk diaper powder. Analyses showed the powder contains 62 % lead by weight (primarily lead oxide) and elevated antimony [1000 parts per million (ppm)], arsenic (55 ppm), bismuth (110 ppm), and thallium (31 ppm). These metals are highly bioaccessible in simulated gastric fluids, but only slightly bioaccessible in simulated lung fluids and simulated urine, suggesting that the primary lead exposure routes were ingestion via hand-mouth transmission and ingestion of inhaled dusts cleared from the respiratory tract. Four weeks after discontinuing use of the powder, the infant’s venous blood lead level was 8 mcg/dL. Unregulated, imported folk remedies can be a source of toxicant exposure. Additional research on import policy, product regulation, public health surveillance, and culturally sensitive risk communication is needed to develop efficacious risk reduction strategies in the USA. The more widespread use of contaminated folk remedies in the countries from which they originate is a substantial concern.

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Acknowledgments

We extend our sincere gratitude to the patient described in this case report and to her family, who consented to sharing their experience via this manuscript in an effort to improve public health. We are also grateful for the chemical and X-ray diffraction analyses provided by USGS scientists Monique Adams, Cyrus Berry, and Rhonda Driscoll.

Funding

Funding for MPK and ADW was provided by cooperative agreement award number 1U61TS000118-05 from the Agency for Toxic Substances and Disease Registry (ATSDR). The contents of this manuscript are the responsibility of the authors and do not necessarily represent the official views of the Agency for Toxic Substances and Disease Registry (ATSDR).

The U.S. Environmental Protection Agency (EPA) supports the Pediatric Environmental Health Specialty Units (PEHSU) by providing funds to ATSDR under Inter-Agency Agreement number DW-75-92301301-5. Neither EPA nor ATSDR endorses the purchase of any commercial products or services mentioned in PEHSU publications. Any use of trade, product, or firm names is for descriptive purposes only and does not imply endorsement by the U.S. Government.

The U.S. Geological Survey (USGS) Mineral Resources Program provided funding for SAM and GSP and supported the analyses carried out in USGS laboratories.

Authors contribution

MPK and ADW conceived of and designed the study. SAM, GSP, TL, and MK planned and performed all laboratory analyses. MPK, SAM, and GSP drafted the manuscript. All authors contributed to the interpretation of results, edited the manuscript, made substantial intellectual contributions to its content, and have approved it for publication.

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Authors and Affiliations

  1. Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, USA

    Mateusz P. Karwowski & Alan D. Woolf

  2. Department of Laboratory Medicine, Boston Children’s Hospital, Boston, MA, USA

    Terence Law & Mark Kellogg

  3. Pediatric Environmental Health Center, Boston Children’s Hospital, 1295 Boylston St, Suite 100, Boston, MA, USA

    Mateusz P. Karwowski & Alan D. Woolf

  4. Department of Pediatrics, Harvard Medical School, 22 Shattuck St, Boston, MA, USA

    Mateusz P. Karwowski & Alan D. Woolf

  5. U. S. Geological Survey, Denver, CO, USA

    Suzette A. Morman & Geoffrey S. Plumlee

Authors
  1. Mateusz P. Karwowski
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  2. Suzette A. Morman
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  3. Geoffrey S. Plumlee
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  4. Terence Law
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  5. Mark Kellogg
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  6. Alan D. Woolf
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Corresponding author

Correspondence to Mateusz P. Karwowski.

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Conflicts of interest

MPK and ADW report grants from the Agency for Toxic Substances and Disease Registry and the U.S. Environmental Protection Agency, during the conduct of the study. All other authors have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Karwowski, M.P., Morman, S.A., Plumlee, G.S. et al. Toxicants in folk remedies: implications of elevated blood lead in an American-born infant due to imported diaper powder. Environ Geochem Health 39, 1133–1143 (2017). https://doi.org/10.1007/s10653-016-9881-6

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  • DOI: https://doi.org/10.1007/s10653-016-9881-6

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