Litarge (Murdar Singh) Ingestion Induced Lead Toxicity: A Case Report.

Ramezani, Yeganeh; Etemad, Leila; Moshiri, Mohammad

doi:10.22038/apjmt.2023.22806

Litarge (Murdar Singh) Ingestion Induced Lead Toxicity: A Case Report.

Document Type : Case Report

Authors

Yeganeh Ramezani ¹

Leila Etemad ²

Mohammad Moshiri ³

¹ Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

² Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran

³ Toxicology department, Imam Reza hospital, Mashhad

https://doi.org/10.22038/apjmt.2023.22806

Abstract

Background: Litarge (Lead II oxide) is named Murder-sang, Murdar Singh or Mordab-Sangh (MS) in person, is applied to reduce body odor in the axillary and legs. Several other indications were mentioned in ancient medicine such as syphilitic chancre wound healing, bed sore, and so forth. We reported lead intoxication by eating a few MS.
Case: A 34-year-old man was visited due to accidentally consuming his wife’s MS powder by adding to his food instead of spices, 10 days earlier. He experienced acute abdominal pain and non-bloody diarrhea 6 hours after ingestion. His symptoms were finally treated by supportive therapy despite their persisted. Ten days later, his blood lead level was 1250 µg/L. His hemoglobin level reduced and transaminase raised to 1.5 times more than the upper limit. He was treated with oral Succimer 10 mg/kg three times a day in the first 5 days and continued by 10mg/kg twice a day up to 21 days. On the 5^th day of treatment, his symptoms improved. His blood lead level was 545.5 µg/L on the 8^th day of treatment and reduced to 254 µg/L and 245 µg/L one and two months later.
Discussion: Mordab-Sangh could induce lead toxicity if ingested. However, other metal poisoning should be considered in MS ingestion

Keywords

Lead Poisoning

Heavy Metal Poisoning, Diarrhea

Chelation Therapy

20.1001.1.23222611.2023.12.2.7.7

Calello DP, Henretig FM. Lead. In: Nelson LS, Howland MA, Lewin NA, Smit SW, Goldfrank LR, Hoffman RS, editors. Goldfrank’s Toxicologic Emergencies,11th ed New Yourk: McGraw-Hill Education; 2019. p. 1294-307.
Vahabzadeh M, Balali-Mood M, Banagozar Mohammadi A, Moshiri M. Efficacy and expenses of succimer vs. d-penicillamine plus garlic in the treatment of lead poisoning: a retrospective cross-sectional study. Daru. 2021;29(2):477-81.
Dadpour B, Mehrpour O, Etemad L, Moshiri M. Lead poisoning-induced hypertensive crisis managed by prazosin: a case report. Iran Red Crescent Med J. 2013;15(6):526-8.
Amirabadi F, Tabrizian K, Rashki A, Rezaee R, Tsatsakis AM, Arsene AL, et al. Lead levels in children deciduous teeth are associated with parents’ education status and daily dairy consumption: an Iranian experience. Farmacia. 2016;64(2):202-9.
Afroz AT, Faisal M. Pharmacology and therapeutics of Murdar Sang (lithargyus): an ancient Unani drug. World Journal of Pharmaceutical Research. 2020;9:2236-41.
Dadpour B, Ghassemi Toussi A, Abbasian Z, shafahi a. Case Report Toxicity of Swamp stone. medical journal of mashhad university of medical sciences. 2019;62(1):1379-83.
Silva D, Tourangeau J, Aglione R, Angeloni M, Brackett C, Dundulis W, et al. Lead poisoning associated with use of litargirio--Rhode Island, 2003. MMWR Morb Mortal Wkly Rep. 2005;54(9):227-9.
Afshari R, Emadzadeh A. Case report on adulterated opium-induced severe lead toxicity. Drug and Chemical Toxicology. 2010;33(1):48-9.
Rahimi K, Dastghosadeh F. [Assessment of total concentrations and dermal bioavailability of heavy metals in Mordarsang] (inpersion ) [Internet]. 2019;Available from: https://he.srbiau.ac.ir/article_13995.html?lang=en (Accessed MAY 22, 2023).
Afzali S, Salimi R, Moradi A, Shiri M. Relationship between Abdominal Pain and Blood Lead Level. Asia Pacific Journal of Medical Toxicology. 2023;12(1):25-8.
Mokhtarifar A, Mozaffari H, Afshari R, Goshayeshi L, Akavan Rezayat K, Ghaffarzadegan K, et al. Cholestasis and seizure due to lead toxicity: a case report. Hepat Mon. 2013;13(11):e12427.
Karimi G, Moshiri M, Etemad L. Review of cases of lead poisoning from opium abuse in Iran. Pharmacol online. 2009;3:897-905.
Rafati Rahimzadeh M, Rafati Rahimzadeh M, Kazemi S, Moghadamnia AA. Cadmium toxicity and treatment: An update. Caspian J Intern Med. 2017;8(3):135-45.