title: Lead intoxication due to ayurvedic medications as a cause of abdominal pain in adults.
abstract: BACKGROUND
  Though a majority of cases of lead intoxication come from occupational exposures, traditional and folk remedies have also been reported to contain toxic amounts of lead. We present a large series of patients with lead poisoning due to intake of Ayurvedic medicines, all of whom presented with unexplained abdominal pain.
  
  
  METHODS
  This was a retrospective, observational case series from a tertiary care center in India. The charts of patients who underwent blood lead level (BLL) testing as a part of workup for unexplained abdominal pain between 2005 and 2013 were reviewed. The patients with lead intoxication (BLLs >25 μg/dl) were identified and demographics, history, possible risk factors, clinical presentation and investigations were reviewed. Treatment details, duration, time to symptomatic recovery, laboratory follow-up and adverse events during therapy were recorded.
  
  
  RESULTS
  BLLs were tested in 786 patients with unexplained abdominal pain and high levels were identified in 75 (9.5%) patients, of which a majority (73 patients, 9.3%) had history of Ayurvedic medication intake and only two had occupational exposure. Five randomly chosen Ayurvedic medications were analyzed and lead levels were impermissibly high (14-34,950 ppm) in all of them. Besides pain in abdomen, other presenting complaints were constipation, hypertension, neurological symptoms and acute kidney injury. Anemia and abnormal liver biochemical tests were observed in all the 73 patients. Discontinuing the Ayurvedic medicines and chelation with d-penicillamine led to improvement in symptoms and reduction in BLLs in all patients within 3-4 months.
  
  
  CONCLUSIONS
  The patients presenting with severe recurrent abdominal pain, anemia and history of use of Ayurvedic medicines should be evaluated for lead toxicity. Early diagnosis in such cases can prevent unnecessary investigations and interventions, and permits early commencement of the treatment.
authors.affiliation: a Department of Gastroenterology , Dayanand Medical College , Ludhiana , India.
authors.forename: Varun
authors.initials: V
authors.lastname: Mehta
authors.affiliation: b Department of Internal Medicine , Dayanand Medical College , Ludhiana , India.
authors.forename: Vandana
authors.initials: V
authors.lastname: Midha
authors.affiliation: a Department of Gastroenterology , Dayanand Medical College , Ludhiana , India.
authors.forename: Ramit
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: c Department of Pathology , Dayanand Medical College , Ludhiana , India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Narang
authors.affiliation: a Department of Gastroenterology , Dayanand Medical College , Ludhiana , India.
authors.forename: Praneet
authors.initials: P
authors.lastname: Wander
authors.affiliation: a Department of Gastroenterology , Dayanand Medical College , Ludhiana , India.
authors.forename: Ridhi
authors.initials: R
authors.lastname: Sood
authors.affiliation: a Department of Gastroenterology , Dayanand Medical College , Ludhiana , India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Sood
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D002614:Chelating Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008515:Medicine, Ayurvedic; D010396:Penicillamine / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D002614:Chelating Agents; D007854:Lead; D010396:Penicillamine
keywords: Lead; abdominal pain; ayurvedic medicine; lead intoxication