succimer and Anemia

A 29-year-old man, who recently emigrated from India, presented with a 2-week history of abdominal pain, as well as nausea, constipation, and fatigue. He underwent removal of a parathyroid adenoma 6 weeks prior to admission and received a locally made Indian traditional medicine (Ayurveda) for pain control; however, this information was not initially available. He was instructed to take approximately 15 g/day. Initial evaluation revealed a normocytic anemia, but other workup including imaging and endoscopy was unrevealing. Given his recent use of Ayurvedic medicines, we tested for lead poisoning and found a blood lead level of 72 mcg/dl. We sent his medicine for analysis and found it had a high lead concentration of 36,000 mcg/g, which is over 25,000 times the maximum daily dose. He improved with cessation of the medicine and treatment with succimer. Lead poisoning can present with a variety of nonspecific signs and symptoms, including abdominal pain and anemia. Ayurvedic medicines, as well as traditional medicines from other cultures, may be a source of lead or other heavy metals. It is essential for physicians to be aware of adverse effects of Ayurvedic medicines as they are easily available and increasing in popularity.

Topics: Abdominal Pain; Adult; Anemia; Humans; Lead Poisoning; Male; Medicine, Ayurvedic; Succimer

Topics: Adult; Anemia; Chelating Agents; Diagnosis, Differential; Foreign Bodies; Humans; Lead Poisoning; Male; Nurse Practitioners; Risk Factors; Severity of Illness Index; Shoulder Injuries; Shoulder Pain; Succimer; Wounds, Gunshot

We present a case history of a 24 years old male who developed autonomic dysfunction, intestinal pseudo-obstruction and anemia due to lead poisoning. Concomitant recording of blood levels of lead and autonomic function showed a gradual decline in blood lead level (98.8 microg/dL at week 0, 56 microg/dL at week 6, and 40 microg/dL at week 52) and gradual improvement in autonomic functions. Decrease in blood lead levels with DMSA (Meso-2, 3-dimercaptosuccinic acid) therapy showed improvement in autonomic functions. At week 0, the patient had severe loss of autonomic tone and autonomic reactivity which improved at week 6. At the 52nd week, most of the autonomic parameters had normalized except for the persistence of mild loss of parasympathetic reactivity.

Topics: Adult; Anemia; Autonomic Nervous System Diseases; Chelating Agents; Erectile Dysfunction; Humans; Intestinal Pseudo-Obstruction; Lead; Lead Poisoning, Nervous System, Adult; Male; Medicine, Ayurvedic; Plants, Medicinal; Succimer