Severe Lead Toxicity Due to Ayurvedic Medicine in a Child with Type 1 Diabetes Mellitus

Excerpt

To the Editor: An 11-y-boy with type 1 diabetes (T1DM) diagnosed 3 mo back, developed increasing pallor, irritability, constipation, anorexia, and episodic abdominal pain requiring multiple hospital visits. Investigations were noncontributory, except hypochromic–normocytic anemia. Subsequently, he developed ketoacidosis and an episode of seizure. MRI brain was normal. Repeated questioning revealed that parents had started giving him Ayurvedic medications (bhasma, bark, and paste) after 2 wk of diagnosis. His glycemic control improved (presumably due to honeymoon phase), and they stopped insulin and glucose monitoring after 2 mo. We suspected lead poisoning, which was corroborated by bluish Burtonian line on gum (Fig. 1) and radiodense line at distal radial metaphysis (Fig. 1). Blood lead level (BLL) was 172 µg/dL (considered to be in lethal range; permitted < 5 ug/dL) [1]. Lead levels in bhasma estimated by mass spectrometry was > 10⁵ ppm (permissible limit 10 ppm) [2]. British anti-Lewisite is recommended as the first-line chelating agent, but daily 6 painful intramuscular injections were causing fever. We started oral chelation with dimercaptosuccinic acid (DMSA) procured online from USA [3], after which BLL fell to 43 µg/dL. In follow-up, child is doing well. …