Elevated blood lead levels in urban moonshine drinkers

Study objective: During a study of problem drinking, we found that surprisi ngly large numbers of emergency department patients reported moonshine cons umption. Because of sporadic reports of moonshine-associated lead toxicity in rural areas, we suspected that urban ED patients might have previously u nidentified elevated blood lead levels caused by moonshine consumption. We initiated an active screening program to identify patients with moonshine-a ssociated elevated blood lead levels. Methods: We performed a prospective case-finding effort at a large urban ED in Atlanta, GA, screening ail patients admitted to the ED for a B-month pe riod during times when study personnel were available. Patients reporting m oonshine consumption within the preceding 5 years were asked to participate . After written informed consent, subjects completed a structured interview administered by one of the investigators, and blood was obtained for deter mination of a whole blood lead level. We recorded the numbers of patients r eporting moonshine consumption, time of most recent consumption, other pote ntial sources of lead exposures, and whole blood lead levels. Results: Of 49 patients reporting consumption of moonshine within the past 5 years, 25 (51%) of 49 had elevated blood lead levels( >15 mug/dL), with 1 5 (31%) of 49 having extremely elevated blood lead levels (>50 mug/dL). Rec ent moonshine consumption (within the past month) was reported by 38 (78%) of 49 patients. Of these 38 recent consumers, 23 (61%) had elevated lead le vels compared with only 2 (18%) of 11 of those reporting more remote consum ption (risk difference 42%; 95% confidence interval 15% to 70%). Conclusion: A high percentage of patients who reported moonshine consumptio n had elevated blood lead levels. Emergency physicians should consider scre ening to determine the prevalence of moonshine consumption in their practic e settings, as well as the possibility of lead intoxication among patients with suggestive symptoms. All patients reporting moonshine consumption with in the past 5 years should be tested for lead exposure.