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[阿育吠陀医学导致的严重铅中毒]

[Severe lead poisoning caused by ayurvedic medicine].

作者信息

Scherbaum Christina Rebecca, Frank Thorsten, Suárez Victor

机构信息

Klinik II für Innere Medizin: Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln.

Klinik für Innere Medizin II (Gastroenterologie und Hepatologie, Diabetologie und Stoffwechselstörungen), St.-Katharinen-Hospital Frechen.

出版信息

Dtsch Med Wochenschr. 2022 Mar;147(5):253-257. doi: 10.1055/a-1743-6718. Epub 2022 Feb 28.

Abstract

HISTORY

We report the case of a young patient who presented to our emergency department with reduced general condition, anemia, and crampy abdominal pain. A previous inpatient workup including abdominal imaging and bone marrow aspiration had not yielded a diagnosis. On inquiry, the patient reported oral ingestion of an Ayurvedic remedy over the course of one month.

FINDINGS

24-year-old circulatory stable patient in reduced general condition with gray skin coloration and a dark gingival margin. Laboratory testing revealed an increase in transaminases and normocytic anemia. A peripheral blood smear showed basophilic stippling of the erythrocytes. Significantly elevated lead levels were detected in the patient's blood and hair. Toxic lead levels were detected in the ingested preparation.

DIAGNOSIS

Severe lead poisoning caused by self-medication with an Ayurvedic remedy. Analysis revealed a daily oral lead load of 136 times the maximum permissible dose.

THERAPY AND COURSE

By means of chelation therapy, the blood lead levels were significantly reduced, and there was a complete regression of the complaints as well as a normalization of the laboratory findings.

CONCLUSION

Lead has toxic effects on all organ systems of the body and is stored in the bone for decades. Symptoms of poisoning are nonspecific; a thorough history and generous indication for measuring lead levels are helpful for the diagnosis.

摘要

病史

我们报告一例年轻患者,因全身状况变差、贫血及腹部绞痛前来我院急诊科就诊。此前住院期间进行的包括腹部影像学检查和骨髓穿刺在内的各项检查均未明确诊断。经询问,患者称在一个月内口服了一种阿育吠陀药物。

检查结果

一名24岁循环稳定但全身状况较差的患者,皮肤呈灰色,牙龈边缘发黑。实验室检查显示转氨酶升高及正细胞性贫血。外周血涂片显示红细胞有嗜碱性点彩。患者血液和头发中的铅水平显著升高。在摄入的制剂中检测到有毒的铅含量。

诊断

因自行服用阿育吠陀药物导致严重铅中毒。分析显示每日口服铅负荷量为最大允许剂量的136倍。

治疗及病程

通过螯合疗法,血铅水平显著降低,症状完全消退,实验室检查结果恢复正常。

结论

铅对人体所有器官系统均有毒性作用,并在骨骼中储存数十年。中毒症状不具特异性;详细的病史及进行铅水平检测的充分指征有助于诊断。

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