Severe Lead Poisoning Managed with Combination Chelation Therapy: Report from a Resource-limited Country

Area of Science:

• Toxicology
• Environmental Health
• Integrative Medicine

Background:

• Increasing reports of heavy metal toxicity, particularly lead, linked to Ayurvedic and alternative medicines.
• Contaminated herbal supplements pose diagnostic and therapeutic challenges due to variable heavy metal content.
• Limited availability of specific chelating agents in resource-poor settings restricts treatment options for heavy metal poisoning.

Purpose of the Study:

• To highlight the importance of considering lead poisoning in patients using alternative medicines.
• To describe a case of severe lead toxicity managed with available chelating agents.
• To emphasize the need for early diagnosis and effective chelation therapy.

Main Methods:

• A case study of a 38-year-old male with lead toxicity secondary to Ayurvedic medication use.
• Initiation of intramuscular dimercaprol for elevated serum lead levels (120 µg/dL).
• Addition of D-penicillamine due to neurological symptoms and unavailability of calcium disodium edetate (CaNa2EDTA), followed by CaNa2EDTA when available.

Main Results:

• The patient presented with vomiting, abdominal pain, and constipation, alongside elevated lead, selenium, nickel, and zinc levels.
• Initial treatment with dimercaprol and D-penicillamine led to clinical improvement.
• Successful management and discharge with no neurological sequelae after transitioning to CaNa2EDTA.

Conclusions:

• Lead poisoning should be suspected in patients with unexplained gastrointestinal or neurological symptoms who consume Ayurvedic or herbal products.
• Early diagnosis and prompt chelation therapy are vital for favorable outcomes in heavy metal poisoning.
• Combination chelation therapy may be a viable strategy for severe cases of lead toxicity.