Lead toxicity from Ayurvedic medicines

Abstract

A 39-year-old woman presented to the emergency department 3 times over 6 weeks with abdominal pain, constipation, nausea and vomiting. She had a medical history of hypothyroidism and infertility, and was taking levothyroxine, follitropin alfa injections and folic acid. She lived in a condominium and worked in an office. She did not drink alcohol and was a nonsmoker. She did not have a notable family history.On her third visit to the emergency department, the patient reported abdominal pain, fatigue, nausea and vomiting. Her vital signs were normal. Her hemoglobin level was 67 (normal 115-155) g/L with a mean corpuscular volume of 88.5 (normal 80.0-98.0) fL. She was admitted to hospital to investigate the anemia and possible gastrointestinal bleeding. Her blood film showed basophilic stippling, slight microcytosis and hypochromasia with no hemolysis. Levels of electrolytes, calcium, magnesium, phosphate, vitamin B 12 , thyroid-stimulating hormone and liver enzymes were normal. Cultures of blood and urine samples were negative. Results of esophagogastroduodenoscopy, colonoscopy and computed tomography and ultrasonography of her abdomen and pelvis were normal. A bone marrow biopsy to investigate the anemia showed a moderate to marked increase in iron storage. Diagnostic laparoscopy for possible endometriosis showed no visible endometriosis. Biopsies of simple ovarian cysts were sent for pathologic examination. The patient's abdominal pain improved and her hemoglobin remained higher than 70 g/L after transfusions. Her discharge diagnosis was anemia of unknown cause and possible mild endometriosis. She was prescribed analgesics, laxatives and her usual medications, and was scheduled for follow-up with the internal medicine and hematology services.At the outpatient follow-up with the internal medicine service 2 weeks after discharge, the patient reported improved abdominal pain but ongoing fatigue, shortness of breath, headaches and tinnitus. A urine sample was sent out for porphyria screening. At the second follow-up 4 weeks after discharge, at which point one of the authors became involved (H.A.), her porphyria screen showed elevated levels of coproporphyrin III and δ-aminolevulinic acid. Her biopsies did not show endometriosis. On further inquiry, the patient reported having taken Ayurvedic medications daily to treat infertility for more than a year. Her regimen varied, ranging from a few to a dozen pills daily. She had stopped taking them before her admission to hospital because of the abdominal pain, but had resumed them after discharge. Her blood lead level was 55 (normal < 2) µg/dL. A history of the patient's occupational and environmental exposure did not reveal other potential sources of lead exposure.

A case report of acute intermittent porphyria leading to severe disability

“…The clinical manifestations of lead poisoning depend on blood lead levels, with high levels leading to anemia, constipation, abdominal pain, peripheral neuropathy, and even impaired consciousness. Patients with lead poisoning typically have a clear history of lead exposure and significantly elevated blood and urine lead levels ( 43 ). An elderly woman with chronic, long-term gastrointestinal symptoms including abdominal pain and weight loss, as well as chronic neurologic symptoms of memory impairment, has recently been reported.…”

Ayurvedic Medicine: A Traditional Medical System and Its Heavy Metal Poisoning

“… 10 Heavy metals such as lead, arsenic, mercury, and cadmium are xenobiotics that can induce toxicity even at low doses. 11 12 13 14 Metals ( bhasmas ) are highlighted as needed for appropriate biological functioning in Rasa Shastra Ayurveda, hence they are purposely implemented after “purification” ( suddha ) in the formulations. However, numerous recent research articles have shown that herbal medications are contaminated with lethal amounts of heavy metals.…”