title: Chronic arsenic toxicity from Ayurvedic medicines.
abstract: BACKGROUND
  Ayurvedic medicines are known to contain arsenic and concentrations up to toxic levels have been reported in certain formulations. However, clinical disease due to arsenic containing ayurvedic medicines has rarely been reported. We seek to highlight the existence of toxic levels of arsenic in certain ayurvedic preparations that can produce serious systemic manifestations.
  
  
  METHODS
  An 11-year-old girl developed manifestations of arsenical keratosis (punctuate palmoplantar keratoderma and leucomelanoderma) and non-cirrhotic portal hypertension, 6 months and 18 months respectively after intake of ayurvedic medications, prescribed for epilepsy. The eight ayurvedic preparations consumed by the patient and her serum levels were analyzed for arsenic content.
  
  
  RESULTS
  Arsenic content of ayurvedic medicines ranged from 5 mg/L to 248 mg/L. The serum arsenic level was 202.20 microg/L (normal < 60 microg/L). Skin manifestations improved after the discontinuation of ayurvedic medications.
  
  
  CONCLUSIONS
  Ayurvedic medications should be consumed under strict guidance and supervision of qualified practitioners to prevent such catastrophies.
authors.affiliation: Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sujay
authors.initials: S
authors.lastname: Khandpur
authors.forename: Amit K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Vidhyut
authors.initials: V
authors.lastname: Bhatia
authors.forename: Subandhu
authors.initials: S
authors.lastname: Gupta
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Rakesh
authors.initials: R
authors.lastname: Mishra
authors.forename: Narendra K
authors.initials: NK
authors.lastname: Arora
mesh_terms: D001151:Arsenic / Q000032:analysis*; D020261:Arsenic Poisoning / Q000209:etiology*; D002648:Child; D002908:Chronic Disease; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000139:chemically induced*; D007194:India; D007645:Keratoderma, Palmoplantar / Q000139:chemically induced* / Q000473:pathology; D008099:Liver / Q000473:pathology; D008515:Medicine, Ayurvedic; D008517:Phytotherapy / Q000009:adverse effects*; D010859:Pigmentation Disorders / Q000139:chemically induced* / Q000473:pathology; D028321:Plant Preparations / Q000737:chemistry / Q000506:poisoning*; D012867:Skin / Q000473:pathology
chemical_list: D028321:Plant Preparations; D001151:Arsenic