Health effects and risk assessment of blood heavy metal levels in children aged 2-18 years of age who applied to balcali hospital pediatric emergency department

Introduction and Objective: There is a high potential risk of heavy metal exposure in our region where agriculture and industry are intensively combined. Children are more sensitive to environmental factors due to their developing physical and mental structures. Heavy metals may have negative effects on children's health and may cause health problems in the long term. Therefore, it is of great importance to avoid heavy metal exposure for both sick and healthy children. The aim of this study was to determine the relationship between environmental and socioeconomic factors and their effects on children's health by analyzing the blood heavy metal concentrations of children admitted to the Pediatric Emergency Department of Balcalı Hospital. Materials and Methods: Blood samples were collected from 197 children aged 2-18 years with or without known diseases who were admitted to the Pediatric Emergency Department of our hospital between October 2022 and January 2023 with their consent to determine the levels of serum aluminum, blood mercury, blood lead and blood cadmium. The blood was centrifuged for aluminum. Blood samples were stored at -80 degrees Celsius until heavy metal analyses were performed. Heavy metal concentrations were measured by ICP-MS after dilution of blood and serum samples at Çukurova University ÇÜMERLAB. Demographic, social, and medical information of the patients were evaluated with a questionnaire. Heavy metal concentrations and demographic, social, medical and laboratory data of the patients were compared to evaluate the risk factors. Results: Our results show that blood lead (mean 7.21 µg/dL), blood mercury (mean blood mercury 4.0±6.9 µg/L) and serum aluminum (mean serum aluminum 11.2 µg/L) concentrations were higher in children compared to other studies. The reason for this may be the intensive industrialization in our region and especially the patients under nephrological follow-up for aluminum. The average heavy metal concentrations in our study were not above the toxic limit. Another result obtained in the study was that blood lead levels were found to be lower in patients diagnosed with chronic allergy-immunology (p=0.036). This is thought to be due to the fact that allergy-immunology patients are more sensitive to air pollution than non-allergy-immunology patients and therefore avoid environments with polluted air. Our study showed that blood lead levels increased with increasing body surface area (p=0.032). However, no such relationship was found between other heavy metals and body surface area. The upper limits for serum aluminum, blood mercury, blood lead, and blood cadmium were 20 mcg/L, 5 mcg/L, 10 mcg/dl, and 0.4 mcg/L, respectively. Patients with serum aluminum levels above 20 mcg/L had a low rate of medication use (p=0.019). Among the medications used by patients with high serum aluminum levels, only anti-phosphate AL contained aluminum chloride hydroxide. This showed us that aluminum exposure may have multiple sources other than oral medications. Patients with serum aluminum levels above 20 mcg/L had lower BMI and MCV values (p=0.046; p=0.019, respectively). Patients with blood lead levels above 10 mcg/dL had significantly higher creatinine levels (p=0.030). The rate of home environment anxiety was higher in patients with blood mercury levels above 5 mcg/L (p<0.001) and the mean pulse rate was lower (p<=0.010). Blood lead and serum aluminum levels were lower in patients who had home renovations in the past 1 year (p=0.020; p=0.009, respectively). This result was thought to be related to that materials such as old structures, installations and paints in houses causes aluminium exposure. Patients with a paternal education level of more than 12 years had higher Hct, Hgb, ANS and albumin levels (p=0.012; p=0.002; p=0.022; p=0.041, respectively) and lower RDW levels than patients with a paternal education level of 12 years or less (p=0.015). Blood cadmium levels were <1.2 mcg/L in all patients included in our study. Conclusion: Exposure to heavy metals is known to occur in various ways. Awareness-raising and educational measures are very important to address this problem. It is important to inform parents, caregivers, and health professionals about the potential risks that children face in their daily lives. This awareness is essential to promote healthy habits and prevent potential sources of harm. Keywords: Heavy metal, child health, toxicity