FYI - Pharmacy Information

Patients presenting with dangerously high lead blood levels

The National Poisons Centre (NPC) and Health New Zealand – Te Whatu Ora is alerting healthcare practitioners to multiple recent cases of severe lead toxicity associated with the use of some Ayurvedic (traditional Indian medicine) products.

At least eight cases have occurred in different North Island locations (primarily Auckland and Bay of Plenty) over the past three months and have been reported to Medical Officers of Health. To date, most of the patients have been adult males of Indian origin who report taking an Ayurvedic product.

In light of these cases, we are encouraging practitioners to be on the look-out for patients who may present with acute lead toxicity. Unfortunately, symptoms are non-specific and patients may present with a variety of gastrointestinal, neurologic, and constitutional complaints. In severe cases, acute lead toxicity can cause seizures, encephalopathy, and death.

In the current cluster, several patients have presented with complaints of abdominal pain with nausea/vomiting or constipation, sometimes with multiple presentations over weeks to months.

The usual initial investigations for these complaints, including imaging and endoscopy, were not revealing a cause for their symptoms. Some of these patients also presented with new onset aenemia with basophilic stippling prompting testing for lead. The presence of basophilic stippling should prompt consideration of lead exposure, however, importantly, the absence of basophilic stippling does not rule out lead exposure.

Therefore, if you encounter a patient of Indian ethnicity with colicky abdominal symptoms without an apparent cause, especially if recurrent or associated with a new aenemia, please screen for exposure by specifically asking about Ayurvedic product use.

Note that sensitivity is required when screening for exposures. Cultural differences, concerns of disapproval from medical providers, or other reasons may contribute to a patient’s reluctance to disclose use of traditional remedies, including Ayurvedic products.

If there is a positive exposure history, then sending a whole blood lead test would be warranted. However, it is important to follow-up as test results will normally take several days.

The National Poisons Centre is available 24/7 to provide advice for any cases of known or suspected lead toxicity, and clinical toxicologists can be contacted via the service by calling 0800 764 766.

Investigations of lead poisoning cases are led by Medical Officers of Health and local public health teams, working in conjunction with Medsafe and other agencies as required. Notifications to the local Medical Officer of Health are required for blood lead level equal or greater then 0.24 µmol/L, who will investigate exposure pathways and test items that may have contributed to the elevated BLL.

If clinicians consider traditional medicine products are involved in cases of suspected lead toxicity, and have obtained samples from the patient, it would be helpful to gather information about how an individual case obtained the product, such as where the patient obtained the product (locally, or from overseas), the name of product if known, when it was obtained, any product labelling details, patient blood results, and whether any other testing of the product has occurred. Please retain the sample for testing and then contact Medsafe at medclearance@health.govt.nz for advice and instructions about forwarding it on.

More information about lead can be found here.

Pharmac decision

Pharmac is listing trientine dihydrochloride 250 mg capsules on the Pharmaceutical Schedule for the treatment of Wilson disease from 1 May 2024 can be seen here