David A. Geier is vice-president of the non-
profit 501(c)3 Institute of Chronic Il nesses,
Inc ( and the non-profit
Autism spectrum
501(c)3 CoMeD, Inc. (www.mercury- David is also the executive
director of ASD Centers, LLC (www. He has been a research
scientist at the National Institutes of Health. BY DaviD a. Geier, Ba, Mark r. Geier, MD, PhD, FaBMG, FaCe, Autism spectrum disorders are transsulfuration metabolites, mitochondrial Urinary Porphyrins
affect male children (five boys diagnosed Researchers have identified a well-established for every one girl). Currently, a diagnosis of Mark R. Geier has an MD and a PhD in
exposure, which recently has been utilized in genetics. He is board certified in genetics by the American Board of Medical Genetics by a physician of early onset of impairments the treatment of patients diagnosed with an and is a Fel ow of the American Col ege of in social interaction, communication, and ASD. Porphyrins, derivatives of the heme (as Epidemiology. Dr. Geier is a founder and unusual stereotyped behaviors. The child found in hemoglobulin) synthesis pathway, medical director of ASD Centers, LLC (www.
provide a means to measure environmental and has been in clinical
little interest in the world or people around exposures.2 Recent studies conducted on
practice for more than 29 years during which time he has been involved in the evaluation profound behavioral problems and delayed urinary porphyrins in patients diagnosed diagnosed with autism spectrum disorders.
or undeveloped skills. Furthermore, a child with an ASD, and in each of these studies, diagnosed with an ASD may display a range mercury-associated urinary porphyrins were of problem behaviors, such as hyperactivity, poor attention, impulsivity, aggression, self- controls.3-8 These observations are consistent
injury, and tantrums. In addition, many often display unusual responses to sensory stimuli increased brain mercury levels,9 increased
such as hypersensitivities to light, certain blood mercury levels,10 increased mercury
sounds, colors, smells, or touch, as well as levels in baby teeth,11 increased mercury
having a high threshold of pain.1
levels in hair samples,12 increased mercury
in urine/fecal samples,13,14 and decreased
a diagnosis of an ASD is exclusively based upon an observational profile for a child, haircuts15,16 among individuals diagnosed
Rev. Lisa Sykes serves as the associate
with an ASD relative to controls. In addition, pastor of Welborne United Methodist Church many of these children have demonstrable mercury-associated urinary pophryins were in Richmond, Virginia. Lisa’s son, Wesley, was diagnosed with autism in 1998 and with mercury poisoning in 2000. Lisa is president medical abnormalities associated with an spectrum. The higher the level of mercury- ASD diagnosis is now possible through the dedicated to the elimination of mercury from use of routine clinical laboratory testing. severe the ASD diagnosis (Asperger’s disorder medicine. She is the author of a compel ing In the patient with an ASD, clinical tests < pervasive developmental delay – not new book on autism titled Sacred Spark
should be run to assess urinary porphyrins, otherwise specified < autism < autism + epilepsy). Furthermore, using the Childhood mitochondrial dysfunction present in many Autism Rating Scale (CARS), a recognized patients diagnosed with an ASD may include test of ASD severity, researchers found a administration of CARNITOR® (L-carnitine).27
significant and increasing correlation between With sufficient CARNITOR® dosing, patients mercury-associated urinary porphyrins and CARS scores prior to blinded lab testing.4
In order to help lower urinary porphyrins, coordination problems, and fatigue or low chelation therapy, a medical treatment that helps to remove heavy metals from the body, resulted in significant reductions in mercury- Hormones
associated urinary porphyrins in patients The ratio of ASD cases between the sexes, diagnosed with an ASD.6-8
girl, likely reflects a male vulnerability to developing an ASD, a hypothesis supported by multiple lines of evidence. This male vulnerability likely indicates an important propanesulfonic acid (DMPS) and meso 2,3 -dimercaptosuccinic acid (DMSA), previously human poisonings, males were found to be shown to significantly lower mercury body significantly more susceptible to mercury burden (and hence lower urinary porphyrins) toxicity than females. Also, in a series of tissue culture experiments, testosterone neurodevelopmental toxicity,17 may improve clinical outcomes for patients diagnosed with the neuronal toxicity of mercury, whereas an ASD.18,19
homocysteine, cystathionine, glutathione, and taurine testing. Supplementation with the toxicity. Further, increased testosterone reported survey data collected from over targeted nutritional interventions using co- was observed to occur in tissue culture, factors to help the transsulfuration pathway, diagnoses.19 The survey includes a list of
45 medications,23 non-drug supplements or
folinic acid, and pyroxidine (vitamin B-6), in biomedical treatments, and nine special diets ASD diagnosed patients with transsulfuration used to treat ASD diagnosed patients. The abnormalities help to improve clinical and inhibiting the conversion of a key regulator parents rated the treatments on a six-point laboratory findings.21-23
metabolite called dehydroepiandrosterone scale. Parents, assessing their children’s condition before and after treatment, rated Mitochondrial Dysfunction
chelation therapy (or the removal of heavy Recent research has supported a role for mild (DHEA-S).28-32 As a result, the body’s
metals) as the highest or best of these 77 mitochondrial dysfunction among patients regulation of testosterone production is disabled, and this causes excessive levels of said that their child “got better” on this carnitine and pyruvate were significantly reduced, while ammonia and alanine levels Transsulfuration Metabolites
were considerably elevated, in patients with Glutathione, sulfate, and cysteine are key testosterone and significantly decreased substances in the transsulfuration pathway of mild mitochondrial dysfunction.24
that help the body to excrete mercury, and Furthermore, investigators have reported recent studies on patients diagnosed with an ASD have revealed significant abnormalities high levels of testosterone and low levels compared to controls, patients diagnosed coordination problems (gross and fine), and profiles on many cognitive tasks, changes with an ASD have a decreased level of these fatigue or low energy.25 Mercury exposure at
in play patterns, decreased eye contact, metabolites that coincides with a decreased low doses is known to cause mitochondrial decreased socialization, lower verbal and higher numerical intelligence, and brain These differences among individuals help patients diagnosed with an ASD.26
hemispheric asymmetries. Consistent with to explain why children with similar mercury Mitochondrial dysfunction tests available this phenomenon, studies of patients with exposure patterns may have different clinical from LabCorp include carnitine, pyruvic acid, naturally higher testosterone levels were outcomes.20
lactic acid, and ammonia. Treatment of the found to display significantly higher numbers using the Autism Treatment Evaluation
Checklist (ATEC) in the areas of socialization,
sensory/cognitive awareness, and health/
physical/behaviors skills18 within about three
months of therapy.
administration to nearly 200 patients diagnosed with an ASD (from young children to young adults), this therapy was found to produce significant ameliorations in hyperactivity/impulsivity, stereotypy, aggression, self-injury, abnormal sexual behaviors, and/or irritability behaviors that frequently occur in patients diagnosed with an ASD, with few non-responders to the therapy. Furthermore, LUPRON® helped to lower blood testosterone levels significantly and was found to have minimal ASDs have a biological basis as demonstrated in clinically adverse clinical effects.29 Other drugs with
known anti-testosterone effects, such as
available lab testing, and currently utilized observational ALDACTONE® (spironolactone), may also have beneficial effects on patients diagnosed symptoms used in the diagnosis of an ASD neglect the with an ASD.36 Menstrual-aged females with
importance of medical evaluations and testing. an ASD diagnosis may benefit additionally from increased estrogen levels from YAZ® of autistic traits than controls.29,33-35
function profile II, dehydroepiandrosterone, (drospirenone/ethinyl estradiol).27
Clinical examinations of patients diagnosed with an ASD reveal that girls with an ASD Conclusion
diagnosis (and even other family members) glucuronide, dihydrotestosterone, estradiol, show a significant delay in the onset of A clinical trial study of the use of anti- observations by a physician. ASDs have a more likely to display elevated rates of biological basis as demonstrated in clinically testosterone-related medical disorders than previously reported. The anti-testosterone available lab testing, and currently utilized neurotypical controls. Among the conditions therapeutic agent of LUPRON® (leuprolide diagnosis of an ASD neglect the importance patients diagnosed with an ASD and/or in their families are hirsutism (excessive hair found to significantly lower testosterone growth); bisexuality or asexuality; irregular denominator of mercury intoxication as an menstrual cycle; dysmonorrhea; polycystic significantly reduce autistic-like behaviors. important causal factor for many patients In some of the patients examined, significant As the biomedical understanding of autism of ovarian, uterine, breast, and prostate within days of administration of LUPRON®, advances at a quickening pace, new testing cancers, tumors or growths. In addition, boys such as better sleep patterns, improvements and treatments are becoming increasingly in attention and hyperactivity, and increased available. Blood and urine testing is essential rates of diagnosed premature puberty.33-35
socialization. In addition, LUPRON® therapy Finally, a cohort study of 70 consecutive helped to significantly ameliorate clinical patients with an ASD diagnosis revealed that more information may now become available their blood samples, collected and analyzed elevated testosterone in the blood, such as at LabCorp, showed significantly increased early growth spurt, early secondary sexual perhaps with causal contributing factors. average levels of serum testosterone, serum changes (e.g., masturbation), body and facial This is an encouraging time with important free testosterone, percent free testosterone, hair, and aggressive behaviors that may be possibilities for all who live and work with to controls.29
clinics across the US can be found on the available from LabCorp includes testicular significantly lower ASD symptoms measured web at
Austin D. An epidemiological analysis
14 Bradstreet J, Geier DA, Kartzinel JJ, et al.
26 Cambier S, Bernard G, Mesmer-Dudons
of the ‘autism as mercury poisoning’ A case-control study of mercury burden in N, et al. At environmental doses, dietary hypothesis. Int J Risk Saf Med 2008; children with autistic spectrum disorders. methylmercury inhibits mitochondrial energy J Am Phys Surg 2003;8(3):76-79.
metabolism in skeletal muscles of the zebra 2 Woods JS, Martin MD, Naleway CA, et al.
15 Adams JB, Romdalvik J, Levine KE,
fish (Danio rerio). Int J Biochem Cell Biol Urinary porphyrin profiles as a biomarker of et al. Mercury in first-cut baby hair of mercury exposure: studies on dentists with 27 Geier DA, Geier MR. Autism spectrum
developing children. Toxicol Environ Chem J Toxicol Environ Health 1993;40:235-46.
3 Nataf R, Skorupka C, Lam A, et al.
16 Holmes AS, Blaxill MF, Haley BE. Reduced
geneticists. Expert Rev Mol Diagn Porphyrinuria in childhood autistic disorder levels of mercury in first baby haircuts of is not associated with urinary creatinine autistic children. Int J Toxicol 2003; 28 Geier DA, King PG, Sykes LK, et al. A
deficiency. Ped Int 2008;50:528-32.
comprehensive review of mercury provoked 4 Geier DA, Kern JK, Garver CR, et al.
17 Domingo JL. Prevention by chelating
Biomarkers of environmental toxicity and susceptibility in autism. J Neurol Sci toxicity. Reprod Toxicol 1995;9:105-13.
29 Geier DA, Geier MR. A prospective
18 Geier DA, Geier MR. A clinical trial of
assessment of androgen levels in patients 5 Austin DW, Shandley K. An investigation
with autistic spectrum disorders: biochemical metal therapy in autistic disorders. Neuro with autism. J Toxicol Environ Health A Endocrinol Lett 2006;27:833-8.
Neuro Endocrinol Lett 2007;28:565-73.
19 Kern JK, Jones AM. Evidence of toxicity,
6 Geier DA, Geier MR. A prospective study
oxidative stress, and neuronal insult in of mercury toxicity biomarkers in autistic autism. J Toxicol Environ Health B Crit Rev of autistic spectrum disorders and other spectrum disorders. J Toxicol Environ Health Med Hypotheses 2005;64:946-54.
20 Geier DA, Kern JK, Garver CR, et al.
7 Geier DA, Geier MR. A prospective
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markers in children with autistic disorders. 21 James SJ, Melnyk S, Fuchs G, et al.
8 Nataf R, Skorupka C, Amet L, et al.
Porphyrinuria in childhood autistic disorder: acid treatment on glutathione redox status Blaylock RL. A possible central mechanism implications for environmental toxicity. in children with autism. Am J Clin Nutr Toxicol Appl Pharmacol 2006;214:99-108.
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9 Sajdel-Sulkowska EM, Lipinski B, Windom
22 James SJ, Cutler P, Melnyk S, et al.
Metabolic biomarkers of increased oxidative elevated cerebellar 3-nitrotyrosine levels. stress and impaired methylation capacity Am J Biochem Biotechnol 2008;4:73-84.
in children with autism. Am J Clin Nutr testosterone-related disorders in women with autism spectrum conditions. 10 DeSoto MC, Hitlan RT. Blood levels of
mercury are related to diagnosis of autism: 23 Mousain-Bosc M, Roche M, Polge A, et al.
34 Knickmeyer RC, Wheelwright S, Hoekstra
Improvement of neurobehavioral disorders J Child Neurol 2007;22:1308-11.
R, et al. Age of menarche in female with 11 Adams JB, Romdalvik J, Ramanujam VM,
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Belmonte MK. Sex differences in the brain: 24 Filipek PA, Juranek J, Nguyen MT, et al.
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36 Bradstreet JJ, Smith S, Granpeesheh D,
25 Weissman JR, Kelley RI, Bauman ML, et
et al. Spironolactone might be a desirable 13 Geier DA, Geier MR. A case series of
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39 intoxicações exógenas em clínica médica

Medicina, Ribeirão Preto, Simpósio: URGÊNCIAS E EMERGÊNCIAS DERMATOLÓGICAS E TOXICOLÓGICAS 36: 472-479, abr./dez.2003 Capítulo III INTOXICAÇÕES EXÓGENAS EM CLÍNICA MÉDICA EXOGENOUS INTOXICATIONS IN CLINICAL MEDICINE Renê Donizeti Ribeiro de Oliveira1 & João Batista de Menezes21Residente em Imunologia. 2Médico Assistente de Toxicologia. Hospital das Clínicas da

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