Grand Rounds

Holi colour inhalation

Medical Sciences Department, Pediatric Oncall, Mumbai

Address for Correspondence: Dr Ira Shah, Medical Sciences Department, Pediatric Oncall, 1, B Saguna, 271, B St. Francis Road, Vile Parle {W}, Mumbai 400056.

Clinical Problem :
A 10 years old boy presented with accidental inhalation and ingestion of golden metallic coloured powder during Holi festival followed by difficulty in breathing within 10 minutes of the episode associated with giddiness. He vomited once and the vomitus contained golden yellow substance. On examination, he had mild to moderate respiratory distress, yellow staining of face, bilateral fine crepts, drowsiness and respiratory rate of 42, min. Other systems were normal. Investigations showed:
• Hemoglobin = 13.5 gm, dl
• WBC count = 16,700, cumm {83 percent polymorphs, 13 percent lymphocytes, 3 percent eosinophils}
• Platelet count = 3,23,000, cumm
• Bilirubin = 2.3 mg percent {Direct = 0.5 percent}
• SGOT = 42 IU, L, SGPT = 26 IU, L
• USG Abdomen = Normal.

His bilirubin normalized after 3 days and prothrombin time and Partial thromboplastin time was normal. A repeat CBC after 6 days was normal. Chest X-Ray showed bilateral lower zone haziness. His pneumonia resolved after 10 days and the child was otherwise asymptomatic

What should this child be screened for_?

Discussion :
Holi is a festival which marks the harvest of rabi crop and the arrival of spring, was traditionally celebrated using natural coloured extracts from seasonal herbs. However gradually, these natural herbs were replaced by synthetic dyes, most of which contain a plethora of chemicals. There is presence of cheap materials like mica, acids, alkalis, pieces of glass, which not only induce skin disorders like abrasion, irritation, itching but can impair vision, cause respiratory problems and also cancer. The major constituent of the colourants in gulals are mostly heavy metals that are known systemic toxins. These heavy metals not only get deposited in the kidneys, liver and bones but are also capable of disrupting the metabolic functions. Broadly, there are three categories of colours available in the market – pastes, dry powder and water colours. Depending on the colour various chemicals are seen namely:
Black colour contains Lead oxide and can cause Renal Failure
Green colour contains Copper Sulphate which can cause Eye Allergy, Puffiness and Temporary blindness
Silver colour contains Aluminium Bromide which is Carcinogenic
Blue colour contains Prussian Blue which can cause Contact Dermatitis
Red colour contains Mercury Sulphite which can cause skin cancer
Golden colour contains Arsenic which can cause skin, bone marrow and liver involvement.
Thus in this child arsenic and other heavy metals should be screened for. Blood Arsenic levels were 13.42 µg, dl and blood mercury and lead levels were normal. DMSA was not available and since child was asymptomatic, BAL was not given. He was advised regular CBC and LFT every weekly and 24 hours urine arsenic excretion after 1 month.

Last Updated: 1st December 2009, Vol 6 Issue 12 Art No. 65

Correct Answers :  yes 100%
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