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

An increasing number of cases of lead toxicity are being reported among patients taking Ayurvedic and other alternative medicines. These medicines may have varying amounts of heavy metals, making the diagnosis confusing and treatment challenging. The unavailability of certain chelating agents in resource-poor settings limits therapeutic options.

A 38-year-old, recently diagnosed diabetic male, presented with complaints of vomiting, abdominal pain, and constipation. There was a history of consumption of Ayurvedic medications and other herbal supplements for the past 2 months. Serum lead levels were 120 µg/dL, for which intramuscular dimercaprol was initiated. Other heavy metals, selenium, nickel, and zinc, were also in the higher range. Due to worsening neurological symptoms and unavailability of calcium disodium edetate (CaNa₂EDTA), D-penicillamine was added to the therapy. Clinical improvement was noted, but D-penicillamine was replaced with CaNa₂EDTA after a few days, when it became available. The patient was discharged from the hospital with no neurological sequelae.

Lead poisoning should be suspected in patients taking Ayurvedic or herbal medicines and presenting with unexplained abdominal or neurological symptoms. Early diagnosis and chelation therapy may improve outcomes. Combination therapy may be tried in patients with severe poisoning.