Annals of Occupational and Environmental Medicine

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; Ann Occup Environ Med 2019;31:e20. Published online August 26, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e20

Background

In Asian countries, including Korea, lead poisoning caused by traditional herbal medicines is often observed in the clinic. However, there have been no reports thus far of lead poisoning caused by drugs that were approved by the Korea Food and Drug Administration (KFDA). Here, we describe seven patients who ingested a problematic natural product-derived drug (NPD).

Case presentation

In July 2018, seven patients visited a university hospital after ingesting an NPD, S. capsules. These patients complained of various symptoms, and their blood lead levels (BLLs) were elevated relative to those of the general population (arithmetic mean: 19.5 ± 11.6 µg/dL, range: 6.28–35.25 µg/dL). The total doses and BLLs were directly proportional to each other among the patients (r = 0.943, p = 0.001). After the patients discontinued drug intake, their BLLs decreased gradually. The capsule was confirmed to contain lead above the standard value (arithmetic mean: 2,547 ± 1,821.9 ppm).

Conclusion

This incident highlights the need to strengthen standards for the management of NPD ingredients in Korea. NPDs are more likely to be contaminated than other drugs. Thorough management by the KFDA is essential to prevent a recurrence. Moreover, systematic health care is needed for many patients who have taken problematic NPDs.

Citations

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Lead and arsenic intoxications by traditional and alternative medicine: men are more sensitive than women
Lucia Gerke, Roland Seifert
Naunyn-Schmiedeberg's Archives of Pharmacology.2024;[Epub] CrossRef
A Case of Severe Lead Poisoning with Basophilic Stippling Teardrop Cell
Wonyang Kang, Seunghyeon Cho, Dae-Young Lim, Suwhan Kim, Won-Ju Park
Journal of Korean Medical Science.2019;[Epub] CrossRef

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A Case of Lead Poisoning due to a Mixture of Talisman Ash: Han Hui Ye, Jae Uk Jeong, Nak Joon Baek, Chang Yul Choi, Man Joong Jeon, Joon Sakong; Ann Occup Environ Med 2013;25:37-37. Published online November 28, 2013; DOI: https://doi.org/10.1186/2052-4374-25-37

Abstract PDF PubReader ePub

Background

Lead is a metal that has no biological function useful for the human body. In Korea, non-occupational exposure to lead has mostly occurred through taking oriental medicine. However, in this paper we report a case of lead poisoning caused by ingesting talisman material.

Case presentation

A 16-year-old male patient complained of severe abdominal pain after taking cinnabar, a talisman material. He was diagnosed with lead poisoning accompanied by acute hepatitis. We confirmed that the cinnabar the patient took contained about 10% elemental lead. After symptom management, the patients’ symptoms, liver function test results, and blood lead concentration level improved.

Conclusion

Lead poisoning can be accompanied by hepatitis, although rarely. As we have confirmed that cinnabar as a talisman material is harmful to the human body, measures to prevent its misuse are needed.

Citations

Citations to this article as recorded by

A systematic review of clinical and laboratory findings of lead poisoning: lessons from case reports
Saeed Samarghandian, Farshad M. Shirazi, Farhad Saeedi, Babak Roshanravan, Ali Mohammad Pourbagher-Shahri, Emad Yeganeh Khorasani, Tahereh Farkhondeh, Jan Olav Aaseth, Mohammad Abdollahi, Omid Mehrpour
Toxicology and Applied Pharmacology.2021; 429: 115681. CrossRef
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
Lead Poisoning at an Indoor Firing Range
Kyung Wook Kang, Won-Ju Park
Journal of Korean Medical Science.2017; 32(10): 1713. CrossRef
Effect of Lead Exposure on the Status of Reticulocyte Count Indices among Workers from Lead Battery Manufacturing Plant
Ravibabu Kalahasthi, Tapu Barman
Toxicological Research.2016; 32(4): 281. CrossRef

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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

Abstract PDF

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

Citations to this article as recorded by

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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A Case Study on the Effect of Chelation Therapy with Dimercaptosuccinic Acid (DMSA) for Lead Poisoning in an Adult: Yong Jin Lee; Korean Journal of Occupational and Environmental Medicine 2010;22(1):69-76. Published online March 31, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.1.69

Abstract PDF

OBJECTIVES
We wanted to investigate the efficacy of dimercaptosuccinic acid (DMSA) for the treatment of lead poisoning in an adult.
METHODS
The chelation therapy was applied using oral DMSA after measuring the blood lead and performing, renal function tests, liver tests and a physical examination. This therapy with oral DMSA 30 mg/kg/day was administered three times a day for 5 days to an adult patient with a pre-chelation blood lead concentration of 75 microgram/dL. Testing was performed by assessing the daily blood lead level, the blood ZPP, the urine ALA, the symptoms and side effects were assessed by conducting a physical examination.
RESULTS
DMSA therapy given for the duration of 5 days reduced the blood lead concentration from 75 microgram/dL to 21.8 microgram/dL. The blood ZPP concentration fell from 366 microgram/dL to 300 microgram/dL. The urine ALA concentration fell from 9.71 mg/L to 0.38 mg/L. In addition, the symptoms of headache, dizziness and abdominal pain that were induced by lead were improved after 2 days of chelation therapy. The vomiting did not improve after 5 days of chelation therapy, but this resolved 14 days following cessation of therapy. No adverse effects of DMSA therapy were seen.
CONCLUSIONS
Oral chelation therapy with DMSA 30 mg/kg/day is possible without being admitted to a hospital and it is generally effective, safe, and relatively inexpensive. DMSA provides a positive effect on adult patients who have lead poisoning.

Citations

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Probit analysis of comparative assays on toxicities of lead chloride and lead acetate to in vitro cultured human umbilical cord blood lymphocytes
Rajashree Patnaik, Rabindra N. Padhy
Interdisciplinary Toxicology.2015; 8(1): 35. 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

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A Case of Chronic Renal Failure and Renal Cancer in a Worker Exposed to Lead: Somin Park, Jongeun Kim, Jungwon Kim, Daegyun Hong, Sangbum Ye, Dongmug Kang, Euna Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(3):272-281. Published online September 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.3.272

Abstract PDF: INTRODUCTION: Studies evaluating rats and mice have provided convincing evidence that renal adenoma and carcinoma are induced by oral doses of lead acetate and lead subacetate, as well as by parenteral doses of lead phosphate. In addition, at least 2 cases of kidney cancer associated with heavy exposure to lead have been reported. However, there is still not enough information to confirm or rule out an association between kidney cancer and exposure to lead.
CASE
REPORT: In this study, we describe a case of kidney cancer in 54-year-old male worker that was exposed to lead-stearate while employed in the polyvinyl chloride processing industry for 17 years. The patient presented with gout and hypertension. Further examination revealed proteinuria, glucose in the urine and elevated blood urea nitrogen/creatinine levels. Renal ultrasonography, renal computed tomography and renal biopsy revealed chronic renal failure and renal cell cancer.
CONCLUSION
We concluded that the gout and chronic renal failure in this case was caused by chronic lead exposure. However, further study is required to determine if the renal cancer was induced by lead exposure.

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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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Lead Poisoning by Administration of Herb Medicine: Yong Zun Kim, Kyung Ah Kim, Young Lim, Im Goung Yun; Korean Journal of Occupational and Environmental Medicine 1990;2(1):64-70. Published online February 28, 1990; DOI: https://doi.org/10.35371/kjoem.1990.2.1.64

Abstract PDF: No abstract available.

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