Heavy metal intoxication from homeopathic and herbal remedies.

Sir, We read with interest the paper by Keen and colleagues.' The case bears striking similarity to that of a 55 year old Indian man recently treated in our hospital. For 9 months he had taken 2-4 tablets daily of a resin extract from the Balsamodedron mukul plant. Each tablet contained 6.5-7.5 mg of lead as well as recordable levels of mercury and arsenic. This was associated with anaemia, abdominal colic, constipation and a lead line of the gums; toxicology screen revealed grossly elevated serum lead levels on two occasions at 1,300 Ag/l and 990 lAg/l, respectively (normal < 50 gLg/l) but no trace of other heavy metals. Intravenous and subsequently oral chelation therapy with dimercaptosuccinic acid was instituted with prompt response. Statistics show that poisoning from homeopathic remedies is an increasing problem with Guy's Hospital Poisons Unit recording 5-15 cases per annum (personal communication). This is probably an underestimate as there is considerable evidence that subclinical cases exist with short-term exposure. The majority ofpeople affected are from the ethnic minorities and the tablets are taken for a wide range of medical conditions. Investigations by the first and third authors confirm that the tablets, though largely manufactured abroad, are freely purchasable in the UK. There continues to be an influx of reports'-4 concerning heavy metal intoxication from herbal and homeopathic remedies despite pleas for standardized practice.5