The Ayurvedic Remedy Rasa Karpura and a Case of Inorganic Mercury Toxicity

Rasa Karpura (RK) is an ayurvedic remedy used in India but not regulated by the Food and Drug Administration (FDA), and contains multiple compounds, such as mercury sulfide. We present the case of a 5-month-old girl who was given RK for constipation. At the emergency department (ED), she presented in acute distress, with tachycardia, tachypnea, altered mental status, and hematemesis. She required intubation for airway protection and, subsequently, was admitted to the pediatric intensive care unit (PICU). Laboratories revealed acute kidney and liver injury, for which continuous renal replacement therapy (CRRT) was initiated. Serum mercury concentration from the patient's initial presentation returned on day 3 of hospitalization at 3534 ug/L (reference value ≤10 ug/L). Chelation therapy with 2,3-dimercaptosuccinic acid (DMSA) was initiated. Mercury levels decreased significantly over hospitalization, and she was extubated on hospital day 12, transferred out of the PICU on hospital day 24, and discharged after 37 days. Her serum mercury concentration was 10.5 ug/L at 196 days, and she received outpatient DMSA chelation. Our case describes the effects and management of mercury toxicity in a pediatric patient because of RK. Additional parental education on non-FDA-regulated remedies, such as ayurvedic medicines, is needed.