ContextMedicinal use of dietary herbal supplements can cause inadvertent arsenic toxicosis.Case PresentationA 54-year-old woman was referred to the University of California, Davis, Occupational Medicine Clinic with a 2-year history of worsening alopecia and memory loss. She also reported having a rash, increasing fatigue, nausea, and vomiting, disabling her to the point where she could no longer work full-time. A thorough exposure history revealed that she took daily kelp supplements. A urine sample showed an arsenic level of 83.6 μg/g creatinine (normal < 50 μg/g creatinine). A sample from her kelp supplements contained 8.5 mg/kg (ppm) arsenic. Within weeks of discontinuing the supplements, her symptoms resolved and arsenic blood and urine levels were undetectable.DiscussionTo evaluate the extent of arsenic contamination in commercially available kelp, we analyzed nine samples randomly obtained from local health food stores. Eight of the nine samples showed detectable levels of arsenic higher than the Food and Drug Administration tolerance level of 0.5 to 2 ppm for certain food products. None of the supplements contained information regarding the possibility of contamination with arsenic or other heavy metals. The 1994 Dietary Supplement Health and Education Act (DSHEA) has changed the way dietary herbal therapies are marketed and regulated in the United States. Less regulation of dietary herbal therapies will make inadvertent toxicities a more frequent occurrence.Relevance to Clinical PracticeClinicians should be aware of the potential for heavy metal toxicity due to chronic use of dietary herbal supplements. Inquiring about use of dietary supplements is an important element of the medical history.

Arsenic (As) is a known carcinogen commonly found in drinking water. An emerging body of evidence suggests that exposure to inorganic As may be associated with nonmalignant respiratory disease. The aim of this study was to determine whether there is an association between As exposure at levels seen in the United States and prevalence of asthma, emphysema, chronic bronchitis, and respiratory symptoms.Urinary As was collected from 5365 participants from the combined 2003–2006 National Health and Nutrition Examination Survey (NHANES) cohorts. Two methods to adjust for organic As component were incorporated into the statistical model. Linear and logistic regression models compared urinary As adjusted for organic As with diagnoses of obstructive pulmonary disease and respiratory symptoms. Geometric mean concentration of urinary As were not significantly different between participants with and those without asthma, chronic bronchitis, and emphysema. Odds of having asthma was 0.71 for participants with the highest quintile of urinary As (≥17.23 μg/dl) when compared to the lowest quintile (≤3.52 μg/dl). A significant association was found between increasing urinary As concentration and decreasing age, male gender, and non-“white” race. A significant association between urinary As and obstructive pulmonary disease and symptoms was not demonstrated in the U.S. population.

Coal-based energy production is the most utilized method of electricity production worldwide and releases the highest concentration of gaseous, particulate, and metallic pollutants. This article aims to systematically review the public health impact of coal-fired power plant emissions on children’s health. PubMed, Web of Science, and Toxline databases were queried for the past 20 years. Inclusion criteria included original scientific articles with (a) coal-fired power plant exposure assessment, (b) at least one primary pediatric health outcome, and (c) assessment of potential sources of confounding and bias. Only morbidity and mortality studies were included; economic analysis and risk assessment studies without a primary health outcome were not included. Of 513 articles initially retrieved, 17 epidemiological articles were included in the final systematic review after screening and eligibility. The articles reviewed showed a statistically significant adverse effect on pediatric neurodevelopment; birth weight and pediatric respiratory morbidity was associated with exposure to coal-fired power plant emissions, primarily particulate matter and polyaromatic hydrocarbon exposure. There is a lack of consistency of exposure assessment and inadequate control of significant potential confounders such as social economic status. Future research should focus on improving exposure assessment models with an emphasis on source-apportionment and geographic information system methods to model power plant-specific emissions.

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