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DOI: 10.1055/a-1743-6718
Schwere Bleivergiftung durch ayurvedisches Heilmittel
Severe lead poisoning caused by ayurvedic medicine
Zusammenfassung
Anamnese Wir berichten den Fall eines jungen Patienten, der sich mit reduziertem Allgemeinzustand, Anämie und krampfartigen Bauchschmerzen in unserer Notaufnahme vorstellte. Eine vorangegangene stationäre Abklärung inklusive abdomineller Bildgebung und Knochenmarkpunktion hatte keine Diagnose erbracht. Auf Nachfrage berichtete der Patient von der oralen Einnahme eines Ayurveda-Präparats über 1 Monat.
Untersuchungen 24-jähriger kreislaufstabiler Patient in reduziertem Allgemeinzustand mit grauem Hautkolorit und einem dunklen Gingivalsaum. Im Labor zeigten sich ein Anstieg der Transaminasen und eine normozytäre Anämie. Der periphere Blutausstrich ergab eine basophile Tüpfelung der Erythrozyten. In Blut und Haaren des Patienten ließen sich deutlich erhöhte Bleispiegel nachweisen. Es gelang der Nachweis toxischer Bleilevel im eingenommenen Präparat.
Diagnose Schwere Bleivergiftung, ausgelöst durch Eigenmedikation mit einem ayurvedischen Heilmittel. Die Analytik ergab eine tägliche orale Bleibelastung vom 136-Fachen der maximal zulässigen Dosis.
Therapie und Verlauf Mittels Chelatortherapie ließen sich die Blutbleispiegel deutlich senken, und es kam zur völligen Regredienz der Beschwerden sowie zu einer Normalisierung der Laborbefunde.
Folgerung Blei hat toxische Wirkungen auf praktisch alle Organsysteme des Körpers und wird für Jahrzehnte im Knochen gespeichert. Die Symptome einer Vergiftung sind unspezifisch; zielführend sind eine gründliche Anamnese sowie die großzügige Indikationsstellung zur Messung der Bleispiegel.
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.
Publication History
Article published online:
28 February 2022
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