Case Presentation:

We present a 56–year–old male, who came to the emergency room with diffuse abdominal pain, decreased oral intake and constipation. Laboratory values showed that hemoglobin had dropped to 9.7 grams per deciliter (from baseline of 14 grams per deciliter). Levels of serum iron, transferrin, haptoglobin, vitamin B12 and folic acid were within normal limits. Patient had a normocytic anemia with elevated reticulocyte count and liver enzymes were mildly elevated. Abdominal computed tomography was normal. He underwent an upper endoscopy and a colonoscopy which were negative. Peripheral smear showed prominent basophilic stippling promoting measurement of blood lead levels that was markedly elevated (101 microgram per deciliter). Emergent chelation therapy with dimercaprol (BAL) and calcium EDTA was started and patient was later discharged on oral succimer for 2 weeks. On further enquiry patient reported travel to India three months back where he was prescribed ayurvedic medicine for diabetes which he had been taking since 2–3 months. The ayurvedic powder was sent for chemical analysis. The lead content was 62 percent%.

Discussion:

The popularity of alternative or complementary medicine has dramatically increased over the years. They are assumed by patients to be safe and free of side effects. The presence of toxic active ingredients or contaminants can lead to adverse reactions with multi system involvement. Ayurveda, a traditional medical system in India, has been in practice for more than 5000 years. Published case reports have demonstrated that ayurvedic formulations may contain large quantities of heavy metals and it is possible that these minerals are added intentionally after the formulations have undergone a “detoxification” process.According to Ayurveda, toxic heavy metals such as lead and mercury play an important role in healthy functioning of the human body. Ayurvedic medications have been used in the past for pain, arthritis, psoriasis, impotence, infertility and as aphrodisiacs. Lead toxicity from ayurvedic medicine, used for diabetes has rarely been reported. To our knowledge there have been only three documented case reports where lead toxicity has occurred from an ethnic remedy taken for diabetes and its long term complications.

Conclusions:

People opt for alternative medicine because they believe it has lesser side effects than a more natural form of therapy. In ayurvedic medicine lead is regarded as an aphrodisiac and its role may have been to counter the impotence associated with diabetes. The present case brings to light the need to take a thorough medical history, including previous and current drug therapy. However, some patients do not consider herbal medications drugs, whereas, others are uncomfortable about providing information on the use of these preparations. Thus physicians must specifically ask patients about their use of unconventional medicines.