Annals of Occupational and Environmental Medicine

Case Report

A Case of Lead Poisoning by Ingesting Herbal Pills Tainted by Lead during the Manufacturing Process: Young Hoo Shin, Jun Seok Son, Young Wook Kim, Chang Ho Chae, Ja Hyeon Kim, Chan Woo Kim, Jun Ho Lee; Korean Journal of Occupational and Environmental Medicine 2010;22(3):271-277. Published online September 30, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.3.271

BACKGROUND
This is a case report of lead poisoning after herbal pill ingestion. We report this case here as a reminder that contamination during the manufacturing process is an important issue regarding herbal pills. Case Report: A 37-year-old male was admitted to the hospital with abdominal pain caused by cholecystitis. He was transferred to the Department of Occupational and Environmental Medicine on 26 December 2008, because of anemia. On follow-up examination post cholecystectomy, the patient had increasing blood lead levels. There was no specific finding in his medical history, but he had been taking herbal pills for 3 months to treat dyspepsia. We performed an analysis on the herbal pills, and determined a lead concentration of 1485 mg/kg. When he was admitted to the hospital, the patient had a blood lead level of 84.13 microgram/dL and a zinc protoporphyrin level was 230 microgram/dL. The patient was treated with 250 mg of Penicillamine, 4 times per day. During follow-up 3 weeks later, the patient's blood lead level had been reduced to 36.52 microgram/dL which allowed us to take him off of Penicillamine. By 7 months follow-up, the patient's blood lead concentration had fallen from 36.52 microgram/dL to 20.93 microgram/dL.
CONCLUSION
Lead poisoning was confirmed by analyzing blood lead levels and the cause was herbal pills. Upon analysis of the herbal pills, we have discovered that the herbal pills contained an amount of lead acquired during the manufacturing process, based on the high levels of this heavy metal in comparison to other metals. Private herbal pill manufacturing plants need systematic management and oversight.

Citations

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Collective exposure to lead from an approved natural product-derived drug in Korea
Dae-Young Lim, Won-Yang Kang, Ji-Sung Ahn, Seunghyeon Cho, Suwhan Kim, Jai-Dong Moon, Byung-Chan Lee, Won-Ju Park
Annals of Occupational and Environmental Medicine.2019;[Epub] CrossRef
Monitoring of Heavy Metal Contents in Commercial Herbal Medicines in Korea: Cultivated Herbal Medicines in the Seoul and Daegu Areas
Seol Jang, Ah-Reum Lee, A-Eong Lee, Go-Ya Choi, Ho-Kyoung Kim
Korean Journal of Environmental Health Sciences.2015; 41(1): 30. CrossRef

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Case Report

A Case of Lead Poisoning After Ingestion of Herb Pills: Se Won Oh, Hyung Jai Lee, Hong Jae Chae, Sung Kwan Lee, Jai Dong Moon, Deok Cho; Korean Journal of Occupational and Environmental Medicine 2007;19(3):231-237. Published online September 30, 2007; DOI: https://doi.org/10.35371/kjoem.2007.19.3.231

Abstract PDF

BACKGROUND
Lead is a common environmental metal and has been used for various purposes for a long time, leading to frequent reports of lead poisoning. The concern about lead poisoning starts has been mostly focused on occupational exposure and is linked to the prevention and management of lead exposure in refining and manufacturing processes. Nowadays, however, there is growing concern about nonoccupational lead exposure by many pollutants. Especially, lead poisoning by herb medicine has commonly been observed in clinics in Southeast Asia and South Korea. This case report contains diagnosis of inpatients who suffered from lead poisoning from a herb medicine, arthritis remedy and who complained of abdominal symptoms and dizziness. The study purpose was to awaken our healthful interest in lead poisoning.
CASE
REPORT: A 53-year-old female patient complaining of abdominal pain, dizziness, and numbness of hand and foot came to our hospital due to the continuation of her anemic finding symptoms while undergoing treatment at a secondary hospital. Her past medical history was unremarkable except she had taken herb pills for about a year which were administered by herb medicine to treat arthritis. Physical examination was unremarkable except for oral ulcer finding. Hemoglobin was 8.5 g/dl, reticulocyte count was 4.10%, bilirubin was 1.3 mg/dl (direct 0.3 mg/dl), and Zinc protoporphyrin 169.12 ug/dl. In urinalysis results, WBC increased to 30~39 /HPF, While AST/ALT, BUN/Cr, PT/aPTT, and nerve conduction velocity were normal. Basophilic stippling was observed through peripheral blood smear. The blood lead level was 80.4 microgram/dl and the urine lead level continued to increase to 541 microgram/l. Analysis of the pills that the patient had been taking showed that they contained 30 mg/g lead. By oral chelation therapy with D-penicillamine four times per day for five days, the patient's hemoglobin increased to 11.8 g/dl, while blood lead level decreased to 39.2 microgram/dl, and urine level to 196 microgram/l. Although the soles of her feet remained cold, but other symptoms and anemia finding were improved considerably. However, after discontinuing D-penicillamine medication, the blood lead level increased to 41.4 microgram/dl again. The further administration of D-penicillamine for five days reduced the blood lead level to 31.5 microgram/dl. At two years after the discontinuance of D-penicillamine, the followup findings were normal; hemoglobin was 13.1 g/dl, hematocrit 39.6%, reticulocyte count 1.22%, blood lead level 13.3 microgram/dl, and urine lead level 9.17 microgram/l.
CONCLUSION
After taking herb medicine pills for one year, the patient was admitted to hospital chiefly complaining of abdominal pain, dizziness, and numbness of the hand and foot. The high blood and urine and lead levels and lead chemical analysis of the herb pills confirmed lead poisoning which was treated with D-penicillamine for five days. The follow-up result after two years indicated normal blood and urine lead levels.

Citations

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Sources, distribution, bioavailability, toxicity, and risk assessment of heavy metal(loid)s in complementary medicines
Shiv Bolan, Anitha Kunhikrishnan, Balaji Seshadri, Girish Choppala, Ravi Naidu, Nanthi S. Bolan, Yong Sik Ok, Ming Zhang, Chun-Guang Li, Feng Li, Barry Noller, Mary Beth Kirkham
Environment International.2017; 108: 103. CrossRef
A Case of Lead Poisoning with Drug-induced Liver Injury after Ingestion of Herbal Medicine
Gi Jung Jeon, Jongha Park, Min Sung Kim, Jong Won Yu, Jae Hyun Park, Min Sik Kim
The Korean Journal of Gastroenterology.2015; 65(6): 375. CrossRef
Adverse Events Associated with Metal Contamination of Traditional Chinese Medicines in Korea: A Clinical Review
Hyunah Kim, Peter J. Hughes, Emily M. Hawes
Yonsei Medical Journal.2014; 55(5): 1177. CrossRef

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