Epidemiologic Notes and Reports Gasoline Sniffing and Lead Toxicity among Siblings -- Virginia

Between March 1983 and December 1984, six of seven children from a family of nine developed lead toxicity from chronic sniffing of gasoline (Table 3). The children ranged in age from 10 years to 17 years; five of the six were boys. Health officials became aware of the problem after neighbors complained that the children were stealing gasoline. Attempts to control their behavior by issuing locking gas caps and providing family and individual counseling were unsuccessful. Neither the parents nor an older sister, who denied sniffing gasoline had elevated blood lead levels.

The family lived in Virginia on an isolated lot in a rural, coastal county on the Chesapeake Bay. Despite a thorough investigation that included analyses of water, paint, and soil samples, no environmental source of lead other than gasoline could be identified. Abandoned automobiles, gardening machinery, and storage cans containing gasoline were easily accessible to the children.

One of the older boys introduced the practice to his siblings after discovering the effects of inhalation while siphoning gasoline. The children would sniff the fumes for 1-2 minutes until feeling the acute effects, which included euphoria, lethargy, loss of appetite, slurred speech, and blurred vision. These symptoms usually lasted several hours. One child reported occasional headaches and vomiting shortly after sniffing the gasoline.

Frequency of usage varied for each child, ranging from once a month to several times weekly. All the children tended to increase the frequency of sniffing during the summer months when they were out of school, and their activities were less supervised. Blood lead values obtained for three of the children during 1984 showed an increase from February through December. A similar trend during the same period was seen in the other family members who reported sniffing gasoline.

In November 1984, a physician found signs of dysdiadochokinesia (dysfunction of ability to carry out rapidly alternating movements) in two of the children, whereas the other four had normal physical examinations. After hospitalization and treatment, their blood lead levels decreased and the children were placed in supervised foster homes. Since placement, all have reportedly stopped sniffing gasoline. Reported by J Owens, MD, L Soles, Middle Peninsula Health District, J Conover, Div of Consolidated Lab Svc, C Armstrong, MD, G Llewellyn, PhD, K Wasti, PhD, G Miller, MD, State Epidemiologist, Virginia Dept of Health; Div of Field Svcs, Epidemiology Program Office, Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Lead in gasoline is present in the form of tetraethyl lead (TEL). It is an organic compound first introduced during the 1920s as a gasoline additive because of its antiknock properties (1). After absorption through inhalation, TEL is metabolized to triethyl lead and then converted to inorganic lead (2).

Gasoline additives are a significant source of lead in the environment, and reduction of the lead content of gasoline has been associated with decreases in blood lead levels in the U.S. population (3). Recently, the U.S. Environmental Protection Agency announced, effective January 1986, a 10-fold reduction in the standard allowable for lead in gasoline, from 1.1 g to 0.1 g per gallon of gasoline, and is currently considering a total ban on all lead additives (4).

Previous reports of lead toxicity from gasoline sniffing have been of American and Canadian Indians (2,5). The acute effects of inhaling gasoline, which may be caused by TEL or other volatile hydrocarbons found in gasoline, have reportedly been similar to those found in the Virginia children (6). More severe effects in those with higher blood lead levels have included seizures and acute metabolic encephalopathy (2).

Chronic gasoline sniffing can result in significant lead toxicity, which may go undetected until severe medical problems arise. Besides providing medical care for lead toxicity, health-care providers need to understand the social and cultural factors influencing young people to abuse chemicals and drugs (5).

CDC recommends that all children between 9 months and 6 years of age be screened for lead toxicity, defined as a blood lead level of 25 ug/dl or greater and an erythrocyte protoporphyrin (EP) level of 35 ug/dl or greater. The most common source of lead in lead poisoning is lead-based paint. As evidenced by this report, older children and adolescents are also at risk of lead toxicity from different sources of lead in the environment (7).

References

1. Rosner D, Markowitz G. A 'Gift of God'?: The public health controversy over leaded gasoline during the 1920s. Am J Public Health 1985;75:344-52.

2. CDC. Lead toxicity secondary to gasoline sniffing among Navajos--Arizona. MMWR 1981;30:366-8.

3. Annest JL, Pirkle JL, Makuc D, Neese JW, Bayse DD, Kovar MG. Chronological trend in blood lead levels between 1976 and 1980. N Engl J Med 1983;308:1373-7.

4. Environmental Protection Agency. Regulation of fuels and fuel additives; gasoline lead content. Federal Register 1985;50:9386-408.

5. Remington G, Hoffman BF. Gas sniffing as a form of substance abuse. Can J Psychiatry 1984;29:31-5.

6. Keenlyside R. The gasoline sniffing syndrome. In: Grandjean P, Grandjean E, eds. Biological effects of organolead compounds. Boca Raton, Florida: CRC Press, 1984;219-25.

7. CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control--January 1985. Atlanta, Georgia: U.S. Department of Health and Human Services, 1985.

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