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.