Table of Contents
This post was at first revealed in German on Univadis.
Core Messages
Lead is used as a diluting agent for illegal medicine these as heroin and cannabis. Having said that, drug end users are not the only ones who need to enjoy out for the toxic heavy metal ― believers in specified classic therapies do as perfectly. The circumstance history of a youthful gentleman, as connected by Victor Suárez, MD, and his colleagues from the College Hospital of Cologne, Germany, which was posted in the German Medical Weekly, illustrates this point.
Presentation and Historical past
The 24-calendar year-old person came to the crisis department since of crampy lessen belly suffering and poor functionality status, according to the authors. Investigations that had been done in the course of a former inpatient hospital remain had not yielded any indicative results. The individual experienced no preexisting conditions other than previous cocaine and cannabis abuse. When asked, the affected individual reported that he experienced acquired an Indian (Ayurvedic) cure from a pal. He experienced been getting two capsules of it just about every day for about a month.
Conclusions
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Client in diminished typical affliction but with ordinary nutritional status
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Regular very important signals
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Diffuse belly force soreness
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Pale gray pores and skin shade and slight gingival gums on the edges
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No proof of a focal neurologic deficit
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Elevated liver enzyme and lipase amounts
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Normocytic, normochromic anemia
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No vitamin B12, folic acid, or iron l deficiency
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Usual kidney purpose
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Elevated ferritin level (671 μg/L)
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Stomach ultrasonography and CT without the need of extra conclusions
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Tests for heavy metals: substantially elevated blood stages of lead (70 μg/dL typical price, <5 μg/dL)
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Elevated urine levels of δ-aminolevulinic acid (42 mg/L normal value, <4.5 mg/L)
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Peripheral blood smear: basophilic spotting of erythrocytes
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Lead also detected in the hair (12.1 μg/g)
According to the authors, the analysis of the capsules taken by the patient revealed that there was 34 mg of lead per two capsules. This corresponds to about 136 times the permissible dose.
Therapy and Course
The patient received chelation therapy (250 mg of dimercaptopropane sulfonate [DMPS] intravenously every 4 hours). The dose was gradually reduced, and the patient was switched to oral administration after 4 days (DMPS 100 mg 3x daily p.o.). The patient’s blood level of lead dropped from 70 μg/dL initially to 57 μg/dL after 5 days on this therapy, according to the authors. The symptoms regressed, and the patient was discharged in good general condition. During a follow-up examination after 3.5 months, the patient was symptom free and in very good general condition. The blood level of lead was 30 μg/dL. The hemoglobin level and levels of liver enzymes and lipase were normal.
Discussion and Recommendations
Suárez and his colleagues report that lead exposure in the population has steadily declined since the 1980s, owing to the ban on lead-based paint and the switch to unleaded gasoline. What is less well known is that drugs and traditional natural remedies that are contaminated with lead can also cause lead poisoning. Around 20% of Ayurvedic remedies contained at least one heavy metal at a potentially toxic dose. Of these medicines, lead was the heavy metal most often detected.
Symptoms of lead poisoning are nonspecific. Initially, patients often have abdominal discomfort (“lead colic”), and there are often changes in the blood count. A thorough study of the patient’s history with regard to occupation, living situation, hobbies, medications — including alternative medicine and drug use — is a key part of the diagnostic process. A suspicion of lead poisoning warrants determining the blood lead level and δ-aminolevulinic acid in the urine.
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