blood lead levels in glue sniffers

Blood Lead Levels in Glue SniffersTUMER TURKBAY,*,1 S. UMIT SARICI,2 EROL KISMET,2

CEMAL AKAY,3 M. RUSEN DUNDAROZ,2

AND IBRAHIM BALCIOGLU4

Departments of 1Child and Adolescent Psychiatry, 2Pediatrics, and 3Pharmaceutical Toxicology, Gulhane Military

Medical Academy, Ankara, Turkey; and Department ofPsychiatry, Istanbul University, Cerrahpasa Faculty of Medicine,

Istanbul, Turkey

Received August 19, 2003; Accepted September 3, 2003

ABSTRACT

The aim of this study was to investigate blood levels of lead (Pb)among adolescents with glue sniffing in Turkey. Blood Pb levels weremeasured in 30 adolescent glue sniffers by atomic absorption spectropho-tometry and compared with those of the 30 healthy adolescents. The Pbcontents of various glue preparations marketed in Turkey and used by theabusers were also measured. Blood Pb levels were significantly higher inthe study group when compared to the control group. Pb was detected atconsiderably high levels in the contents of all the various glue preparationsmost commonly used by the cases in the study group. The increased bloodPb levels in glue sniffers may be related to the high lead contents of gluesmarketed in Turkey. The blood Pb levels and signs of Pb toxicity should beinvestigated in examination of glue sniffers.

Index Entries: Adolescents; glue sniffing; inhalant abuse; lead;addiction.

INTRODUCTION

Lead-induced toxicity is one of the major public health concernsbecause it affects many organ systems, including central and peripheralnervous systems, red blood cells, kidneys, the cardiovascular system, andreproductive organs (1). At toxicologically silent doses also, lead (Pb)causes deficits in psychological functions, including intelligence, learning

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*Author to whom all correspondence and reprint requests should be addressed.

ability, perception, distractibility, impulsivity, hyperactivity, nonpersis-tence, and language function, and may even be responsible for criminalbehavior (2).

Intentional inhalation (sniffing) of volatile substances as an addiction(inhalant abuse) is an important problem among adolescents (3). The mostcommon forms of inhalant abuse are glue and thinner sniffing, and severedamage to various tissues and organs and similar mechanisms of toxicity,including changes in the activities of antioxidant enzymes and increase inlipid peroxidation, has been reported in both inhalant abusers and outdoorpainters working with paint thinner (4,5). Furthermore, blood Pb levelswere found to be higher than normal in a study investigating the extent ofcytogenetic damage in outdoor painters (6). Although plasma and ery-throcyte levels of various trace elements, including selenium (Se) and zinc(Zn), have been studied in inhalant abusers (7), blood levels of Pb, to ourknowledge, have not previously been investigated in these abusers whoare exposed to the same organic solvents as outdoor painters.

In the present study, we aimed to measure blood levels of Pb hypoth-esizing that glue sniffers would have higher Pb levels resulting fromchronic inhalation of solvent substances just like outdoor painters.

MATERIALS AND METHODS

Subjects

This study was performed at the Ankara Education and Rehabilita-tion Center, where inpatient and outpatient substance abuse treatment andprevention programs were conducted between September 2000 and July2001.

The study group consisted of 30 boys, whose ages were between 11 to18 yr (mean: 15.3 ± 2.2 yr) and who were admitted by their parents or rel-atives because of glue sniffing. The presence and duration of glue sniffingwere confirmed after interviewing with each case, and the diagnosis ofaddiction of a volatile substance inhalation was established according tothe DSM-IV criteria (8). The duration of the abuse ranged from 2 to 6 yr,with a mean of 3.8 ± 0.8 yr. The investigation was done in accordance withthe institutional guidelines for ethics in clinical studies. The parents andofficial authorities were informed about the study and an informed con-sent was obtained from the cases and/or their parents.

Thirty healthy volunteer adolescents of similar age (mean: 15.5 ± 2.4yr) without any addiction were chosen as the control group. A brief historywas taken, a complete physical examination was performed, and bloodsamples for complete blood count and renal and liver function tests wereobtained in each case in the study and control groups. Cases with anysigns or symptoms of any acute or chronic illness or abnormal biochemi-cal test were excluded from the study.

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Methods

Ten milliliters of whole blood was collected by venipuncture after anovernight fasting between 8:00 and 9:00 A.M. Blood samples were dilutedwith 1.0 Triton X-100 (Riedel-de Haen, 80200) in a 1 : 2 ratio. Blood Pb lev-els were then measured using an atomic absorption spectrophotometer(Model AA 30/40 Varian Spectra Graphite Tube Atomizer; Varian TectronPty, Mulgrave, Victoria, Australia). The measurements were made at 283.3nm with the graphite tube atomizer technique. Results were given asmicrograms per deciliter.

Lead contents of the various glue preparations marketed in Turkeyand used by the abusers were also measured. Glue samples (each approx0.2 g) were weighed by a balance (Mettler AT-201, Switzerland), and 3.0mL nitric acid (Merck, extra pure K15920143), 3.0 mL hydrofluoric acid(Merck, supra pure, B348335), and 1.0 mL of 30% hydrogen peroxide solu-tion (Merck, medical extra pure, stabilized, K23641197 703) were added toeach glue sample. The samples were then placed on Milestone microwavedigestion unit (MLS-1200 Mega, Italy) for acid digestion. The determina-tion of Pb levels was performed with the same technique as for blood Pblevel on the same atomic absorption spectrophotometer. Results weregiven as nanograms per gram.

Statistical Analysis

The results were given as mean ± standard deviation. Statistical com-parison of the data of the study and control groups was made using theStudent’s t-test. Probability values (p) less than 0.05 were considered to bestatistically significant.

RESULTS

The mean blood level of Pb was significantly higher in the studygroup when compared to the control group (see Table 1). Pb contents of thevarious glue preparations marketed in Turkey and used by the cases in thestudy group are shown in Table 2.

Lead and Glue Sniffers 47


Table 1Comparison of the Blood Levels of Pb in the Study and Control Groups

* Values are given as mean ± SD.

DISCUSSION

We have previously shown significant decreases in erythrocyte andplasma levels of Se and plasma level of Zn in adolescent volatile substanceabusers and hypothesized that these alterations might lead to a decrease inthe activity of antioxidant enzyme systems (7). Subsequently, we havedemonstrated increased malondialdehyde levels and decreased glu-tathione peroxidase activities in erythrocyte and plasma of inhalantabusers, indicating the presence of oxidative damage and lipid peroxida-tion (4). However, the blood Pb level, one of the markers of volatile sub-stance toxicity in adults working with paint thinners (6), has not beeninvestigated in adolescents with glue sniffing.

The present study is the first determining blood levels of Pb in ado-lescents with glue sniffing. The increased blood Pb levels in these adoles-cents as compared to healthy controls must be the result of the glue vaporitself because the measured Pb contents of all of the various glue prepara-tions most commonly used by glue sniffers were considerably high.Increased blood Pb levels have been deemed responsible for the increasedoxidative stress and lipid peroxidation in adult workers exposed to occu-pational Pb (9). Regarding the clinical importance of increased blood Pblevels in our study group, it also may have had a similar role in the patho-physiology of inhalant volatile substance toxicity. Although the parame-ters of oxidative stress and lipid peroxidation were not studied in thepresent study, which we have previously shown, increases in oxidativedamage and lipid peroxidation in adolescents with inhalant volatile sub-stance abuse suggest that the increase in blood Pb may be responsible foror may be a marker of inhalant volatile-substance-induced toxicity.

The physiopathological relationship between blood Pb increase andvolatile substance toxicity and the clinical importance of Pb toxicity in ado-lescent abusers remain to be determined in further large-scale studies.However, the blood Pb level and signs of Pb toxicity also should be inves-tigated in the examination of volatile substance abusers because Pb maymediate or be a marker of oxidant stress and lipid peroxidation. In addi-tion to establishing preventive measures to restrict inhalant abuse and mis-

48 Turkbay et al.


Table 2Lead Contents of Various Glue Preparations Used by the Cases in the Study

* Each capital letter represents a different preparation.

use of volatile substance, trying to reduce the Pb content of these sub-stances may be one of the most efficient ways to avoid toxicity associatedwith volatile substance inhalation in adolescents.

ACKNOWLEDGMENT

The authors thank the Ankara Education and Rehabilitation Centerfor their permission to study on their subjects. The clinical investigationprocedure of this study complies with the current laws of the country inwhich the investigations were performed.

REFERENCES

1. A. C. Todd, J. G. Wetmur, J. M. Moline, et al., Unraveling the chronic toxicity of lead: anessential priority for environmental health, Environ. Health Perspect. 104, 141–146 (1996).

2. D. C. Rice, Behavioral effects of lead: commonalities between experimental and epi-demiologic data, Environ. Health Perspect. 104, 337–351 (1996).

3. T. L. Kurtzman, K. N. Otsuka, and R. A. Wahl, Inhalant abuse by adolescents, J. Adolesc.Health 28, 170–180 (2001).

4. M. R. Dundaroz, T. Turkbay, C. Akay, et al., Antioxidant enzymes and lipid peroxidationin adolescents with inhalant abuse, Turk. J. Pediatr. 45, 43–45 (2003).

5. I. Halifeoglu, H. Canatan, B. Ustundag, et al., Effect of thinner inhalation on lipid per-oxidation and some oxidant enzymes of people working with paint thinner, Cell Biochem.Funct. 18, 263–267 (2000).

6. D. Pinto, J. M. Ceballos, G. Garcia, et al., Increased cytogenetic damage in outdoorpainters, Mutat. Res. 467, 105–111 (2000).

7. M. R. Dundaroz, T. Turkbay, S. U. Sarici, et al., Selenium and zinc levels in volatile sub-stance abusers, Biol. Trace. Element Res. 88, 119–123 (2002).

8. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., American Psychiatric Asso-ciation, Washington, DC (1994).

9. X. B. Ye, H. Fu, J. L. Zhu, et al., A study on oxidative stress in lead-exposed workers, J.Toxicol. Environ. Health A 57, 161–172 (1999).

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blood lead levels in glue sniffers

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