QUESTION: Connection between myopathy, elevated CKemia and a young child's elevated blood lead level 06 Jun 2008 Slovakia

Hallo. I am medical doctor and few weeks ago I took care of 4-year old boy with muscle weakness, elevated CK kinase and lactatdehydrogenase. We examined also blood lead level. It was 12.8 µg/dL (the normal value for children in our laboratory is 7 µg/dL) I wonder if there is connection between myopathy, elevated CKemia and the elevated blood level. I have found just two brief abstracts on PubMed. Do you have any information, which could help me?

Thank you very much

Slavomira Stankova, MD

Slovakia, Europe

ANSWER: 03 Sep 2008

Dear Dr Stankova,

Many apologies for not noticing until now your important email, among the thousands in our inboxes.

On all medical research matters I now immediately refer to the latest compendium of research from the US Agency for Toxic Substances and Disease Control. In the ATSDR's 582 page "Toxicological Profile for Lead" - you will find several references to muscle weakness in both children and adults, but all are related to higher blood lead levels, for example above 40 µg/dL in workers. It may be that I have found one of the references that you already found, but when I searched the ATSDR Profile for lactate dehydrogenase, I found the following, again, about (workers with) much higher blood lead levels than the boy you are enquiring about:

"A study of workers in the United Arab Emirates reported that a group of 100 workers with a mean PbB of 78 μg/dL had significantly higher concentrations of amino acids in serum than 100 controls whose mean PbB was 20 μg/dL (Al-Neamy et al. 2001). Tests for liver function that included serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities found small (≤10%) but statistically significant increases in alkaline phosphatase and lactate dehydrogenase activities in the serum of the workers."

[Ref: F.R.M. Al-Neamya, A.M. Almehdib, R. Alwashc, M.A.H. Pashac, A. Ibrahimd & A. Benere. Occupational lead exposure and amino acid profiles and liver function tests in industrial workers. International Journal of Environmental Health Research Volume 11, Issue 2, 2001 181-188. See Abstract at www.ncbi.nlm.nih.gov/pubmed/11382350 ]

Regarding lead and kinase, from the Profile all the research to date seems to be on animals or workers which makes me wonder whether you are in a position to actually do some research in children?

I'm sorry if the above information does not help you but I hope that the Info Pack I will send you on the dangers of a blood lead level above 2 µg/dL will help to motivate the powers-that-be to bring down average blood lead levels in your area. I sincerely hope that 7 µg/dL is only normal for the children whose blood is tested at your lab because you receive blood samples from a smelter community or other obvious source of lead. The children's mean blood lead level in the United States is well below half that level so, if there is no point source influence in that average blood lead level, then it is particularly concerning.

Is there a lead poisoning prevention policy actively being pursued in Slovakia or at least in your area? If not, you may be interested in referring your health minister to our "Model National Public Health Policy on the Prevention of Lead Poisoning: An outline proposal"

I look forward to any news about lead poisoning in Slovakia from you.

Yours Sincerely

Elizabeth O’Brien