Moonshine Whiskey and Lead Poisoning

The use of automobile radiators containing lead-soldered parts in the illicit distillation of alcohol (i.e., "moonshine") is an important source of lead poisoning among persons in some rural Alabama counties. From March 5 through October 26, 1991, eight persons were diagnosed with elevated blood lead levels (BLLs) at a local hospital and were reported to the notifiable disease surveillance system maintained by the Alabama Department of Public Health (ADPH). None of these patients had known histories of occupational or other potential sources of lead exposure, but all reported recent histories of moonshine ingestion. This report summarizes the results of an investigation of these cases conducted by the ADPH during December 1991. A case-patient was defined as any person aged greater than or equal to 17 years who presented to the hospital from January 1, 1990, through December 31, 1991, and had a BLL greater than or equal to 15 ug/dL. Laboratory records of specimens submitted for blood lead determination, and medical records were reviewed at the hospital. In addition to the eight patients reported to the ADPH, review of laboratory records identified one patient with a BLL of 35 ug/dL during November 1990. Patients ranged in age from 28 to 64 years (median: 33 years); five were female. Five patients resided in the county in which the hospital is located, and four lived in adjacent counties. All nine patients had been evaluated for alcohol-related medical conditions at the hospital. Manifestations included generalized tonic-clonic seizures (six), microcytic anemia (five) (hematocrit mean: 32.1%), encephalopathy (two), upper extremity weakness (one), and abdominal colic (one). BLLs ranged from 16 ug/dL to 259 ug/dL (median: 67 ug/dL). Seven patients required hospitalization for 48 hours or longer (range: 2-18 days). Three of these received chelation therapy; initial BLLs were 67, 228, and 259 ug/dL. One patient, whose BLL was 67 ug/dL, died during hospitalization from alcohol-withdrawal syndrome complicated by aspiration pneumonia. Patients reported moonshine ingestion ranging from 0.2 L per day to 1.5 L per day. No specimens of moonshine consumed by the patients were available for analysis. However, the lead contents of specimens of moonshine confiscated from two radiator-containing stills in the county in 1991 were 7400 ug/L and 9700 ug/L, compared with nondetectable amounts (less than 1.0 ug/L) in municipal water from the county. Consumption of 0.5 L per day of moonshine containing 9700 ug/L lead would result in a steady state BLL of approximately 190 ug/dL. * Reported by: T Dix, S Walker, MD, Crenshaw County Hospital, Luverne; D Cosby, Alabama Alcohol Beverage Control, Andalusia; CH Woernle, MD, State Epidemiologist, Alabama Dept of Public Health. Div of Field Epidemiology, Epidemiology Program Office; Lead Poisoning Prevention Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health and Injury Control, CDC.