Lead poisoning – a differential diagnosis for abdominal pain

• Published in: The Lancet (British edition) 2005-12, Vol.366 (9503), p.2146-2146
• Main Authors: Frith, Daniel, Yeung, Karen, Thrush, Steven, Hunt, Beverley J, Hubbard, Jonathan GH
• Format: Article
• Language: English
• Subjects: Abdominal Pain - diagnosis; Adult; Blood; Chelation Therapy; Diagnosis, Differential; Female; Folk medicine; Humans; Lead - analysis; Lead poisoning; Lead Poisoning - diagnosis; Lead Poisoning - etiology; Lead Poisoning - therapy; Mercury - analysis; Pain; Plant Preparations - adverse effects; Plant Preparations - analysis; Poisons; Rheumatoid arthritis; Stomach; Toxicity; Urea
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(05)67893-2

A 35-year-old white woman presented to us in December, 2003, with severe, peri-umbilical abdominal pain associated with weight loss, nausea, and lethargy. During the previous 3 months, she complained of tenesmus and straining to pass stool, and had passed blood per rectum. She had a history of rheumatoid arthritis, and had symmetrical wrist pain and swelling. 6 weeks earlier she had consulted an Ayurvedic specialist for her abdominal pain, who prescribed herbal liquids (Maharasanadi Kashayam 20 mL three times daily, Amratanshta 10 mL twice daily) and tablets (Mahayogaraj Guggulu 1 tablet three times daily). After 4 weeks the pain had not settled, and she was advised to double her dosage of Ayurvedic medication. When she presented to us, she appeared unwell. She was tender in the peri-umbilical region, although this was not consistently reproduced on palpation. There were no other abnormal signs. She was admitted and investigations showed a normochromic, normocytic anaemia (haemoglobin 104 g/L, mean corpuscular haemoglobin 28.0 pg, mean corpuscular volume 84 fl, packed-cell volume 0.345), with mildly deranged liver and renal profiles (alkaline phosphatase 67 IU/L, billirubin 35 µmol/L, alanine aminotransferase [ALT] 24 IU/L, γ-glutamyl transpeptidase 8 U/L, sodium 134 mmol/L, potassium 3.5 mmol/L, urea 1.0 mmol/L, creatinine 70 µmol/L, chloride 94 mmol/L, bicarbonate 25 mmol/L); haematinics (vitamin B12, serum folate, and ferritin) were within normal limits, reticulocyte count was 158×10^sup 9^/L, and the blood film was normal. Her anaemia was attributed to arthritis. The local poisons unit informed us that Mahayogaraj Guggulu was an Indian remedy for rheumatoid arthritis; there was no information available about the other therapies.