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Folk Remedy-Associated Lead Poisoning in Hmong Children -- Minnesota

Between January 1, and June 30, 1983, 35 children with lead toxicity* were identified through routine screening by the St. Paul, Minnesota, Division of Public Health. Of these, 24 (69%) were Hmong refugees from Northern Laos. This represents a twofold to threefold increase in the number of Hmong children found to have lead toxicity in St. Paul compared with previous years. One source of lead poisoning appears to be a Hmong folk remedy used for treating infants and children with fevers. A case report follows:

On May 3, 1983, a 6-month-old Hmong girl was found to have lead poisoning (blood lead (BL) 60 ug/dl, erythrocyte protoporphyrin 263 ug/dl, hematocrit 38%) during screening for well-baby care. She was asymptomatic at the time. Her physical examination was unremarkable. X-ray films of the wrists and knees revealed dense provisional zones of calcification suggestive of lead deposits. No environmental sources of lead, such as paint, could be identified after a thorough investigation of the family's home. After detailed questioning by the child's pediatrician, the parents admitted giving red and orange powders to the baby as a cure for high fever. Laboratory analysis of the red powder showed a lead concentration of 8%. The infant was given ethylene diamine tetraacetic acid (EDTA) chelation therapy as an outpatient.

Officials have been unable to obtain samples of the folk remedy from the parents of other Hmong children with lead poisoning. The remedy, generally refered to as "pay-loo-ah," consists of red and orange powders, the composition and source of which often vary; therefore, a more exact description of the material remains difficult. Believed to have originated in China or Southeast Asia, pay-loo-ah is fed to children as a cure for fever or rash. Samples of folk remedies were obtained from several Hmong households in the community, and the U.S. Food and Drug Administration confirmed that two contained lead (1% and 90%). Arsenic was found in three samples at concentrations of 70%-80%. These folk remedies were in wide use and were easily available through local Asian food stores or Hmong peddlers. To date, no cases of arsenic poisoning in the Hmong children have been reported. Reported by C Levitt, MD, Children's Hospital, St. Paul, D Paulson, MD, K Duvall, MPH, J Godes, MPH, St. Paul Div of Public Health, AG Dean, MD, State Epidemiologist, Minnesota State Dept of Health; J Roberts, J Egenberger, Minneapolis District, US Food and Drug Administration; Special Studies Br, Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Folk remedies have been known to cause lead poisoning. A Mexican folk medicine, azarcon, has been reported to cause lead poisoning in Mexican children in a number of southwestern states (1,2). Hmong refugees, who have emigrated from North Laos, have an estimated total population over 50,000 and live in many parts of the United States, with the largest concentrations in Fresno, Stockton, and San Diego, California, in addition to St. Paul.

Health-care providers for Hmong and Southeast Asians should be aware of this unusual lead source. Screening for elevated blood lead levels is necessary to identify additional cases, because symptoms of lead toxicity generally have not been reported by the Hmong. Reporting of cases to local or state health departments is recommended. Appropriate health education will be necessary to inform the Hmong of the health consequences associated with this folk remedy.

Lead poisoning resulting from folk remedies exemplifies the need to continue screening young children for lead toxicity. CDC recommends routine screening of EP of all children between 6 months and 5 years of age. An EP level of over the CDC recommendation of 50 ug/dl indicates either iron deficiency anemia or lead toxicity (3). Lead toxicity should then be confirmed by a blood lead level.

References

  1. Bose A, Vashistha K, O'Loughlin BJ. Azarcon por Empacho--another cause of lead toxicity. Pediatrics 1983;72:106-8.

  2. CDC. Lead poisoning from lead tetroxide used as a folk remedy--Colorado. MMWR 1982;30:647-8.

  3. CDC. Preventing lead poisoning in young children: a statement by the Center for Disease Control. April 1978, page 4.

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