Monday, 26 May 2008

Lead toxicity and herbal medication

May 26, 2008
By Syed Akbar
Many people believe that herbal medicines are a safe bet. They think that allopathic drugs cause side-effects while herbal medication is good for the body and the mind.
But a team of researchers from Bangalore has come out with a scientific study which points out that many herbal medicines contains poisonous heavy metals, particularly lead. Injudicious use of herbal medicines will result in accumulation of lead in the blood causing severe health complications.
A study by T Venkatesh, A Ravi Raja, GN Vishal Babu and Geraldine Menezes of the department of biochemistry and biophysics, St John’s Medical College, Bangalore, some of the herbal medicines prepared from certain roots and leaves contain lead at alarming levels.
“Awareness about the toxic effects of non-essential metals is still lacking in developing countries. Lead is one among them, which ranks second in the Agency for Toxic Substances and Disease Registry’ s top 20 list of toxic metals. Some of the herbal medicines prepared from certain roots and leaves are known to contain this toxic metal at alarming levels.
We came across a person, who suffered from the toxic effects of lead such as vomiting and colicky abdominal pain after consuming an herbal remedy for jaundice treatment. This went unrecognised initially because of the presence of multiple problems like malaria and renal calculi. Lead poisoning as causative factor for anemia, vomiting and colic were confirmed only when blood lead concentration was estimated. A combination of chelation therapy and nutritional supplementation was found to be useful in reducing the body lead burden,” Venkatesh told this
correspondent from Bangalore.
Lead enters the body by routes such as inhalation, ingestion or by dermal contact, undergoes cumulative storage and it has no known biological functions. Major organs and systems like nervous system, hematopoietic system, digestive system, cardiovascular system, reproductive system, skeletal system, immunological system and renal system are affected by lead. People are exposed to lead from different environmental sources such as air, soil, food, drinking water or from different occupational and recreational sources and also occasionally from sources like folk
remedies, cosmetics, moonshine whisky and gasoline huffing. Folk and herbal remedies from the Indian subcontinent are a significant unrecognised source of lead toxicity.
A 39year old male patient from a village in Goa was referred to National Referral Centre for Lead Poisoning in India, Bangalore, for the evaluation of lead poisoning. History revealed his habitual consumption of herbal medicines for any kind of illness. This time he had consulted a traditional practitioner for the treatment of jaundice in his village, who gave him syrup known in local language as Kadda.
After consuming 10 to 15 ml of Kadda everyday morning on empty stomach, for a period of 10 days, the patient experienced vomiting and severe abdominal pain. As the syrup did not cure jaundice he was admitted to Government Hospital for the treatment twice, on two occasions within a short period of two weeks.
All possible investigations including HbSAg and HIV were carried out. Results of biochemical investigations showed all normal except for mild elevation of total serum bilirubin -1.6 mg/dl (normal-0.2 to 1.0mg/dl) and Unconjugated bilirubin –1.3mg/dl (normal-0.2 to 0.6 mg/dl) suggestive of hemolytic jaundice. An abdominal CT scan revealed the presence of a 3mm calculus on the left kidney.
With persisting vomiting and severe abdominal pain, he was referred to a superspeciality private hospital in his place. At the time of admission - blood pressure was 130/90 mm of Hg; pulse rate was 76/minute and had no history of diabetes mellitus and hypertension.
Laboratory investigations showed a decrease in hemoglobin 7.8 grams. Repeat CT scan confirmed the presence of left renal calculus. Endoscopy was normal. A barium meal and follow through study did not reveal any abnormality in the small bowel. Two days later after the admission the patient suffered from fever with chills. So test for malaria along with ICT, WIDAL, tests for Leptospira, Brucella, and dengue were carried out. All tests were negative.
A surgical opinion was sought because of the persistent abdominal pain and fever. Urine examination, which was normal initially, had shown 10-12 WBCs on repeat examination. During this time as a work up for anemia, a rectic count was done which was raised and suspected a possibility of hemolytic anemia; the entire work up for hemolytic anemia included sickle test, hemoglobin variant analysis.
As the fever was not coming down, the smear for malaria was repeated including the indirect Coomb’s test that was positive this time and Chloroquine was given. It was also noted that the W.B.C count was progressively coming down and showed leucopenia on the blood picture and a possibility of drug-induced cause was found out.
The fever and vomiting gradually subsided but not the abdominal pain. A bone marrow examination revealed microcytic blood picture. Finally doctors suspected lead poisoning and the patient was sent for blood lead analysis to the NRCLPI. He presented with extreme weakness of both lower limbs and abdominal pain. His blood pressure was 132/86 mm Hg, Heart rate 84/min.
Most significant findings were elevated blood lead level and elevated systolic and diastolic blood pressure.

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