Acute lead poisoning due to mistaken intake of Shidudan (湿毒丹)

A 27-year-old female patient visited private clinic because of irregular menses. The private clinic pharmacist dispensed by mistake Shidudan (湿毒丹) containing lead powder 31 g and minium 62 g as Sanqifen (三七粉) to the patient. The patient developed abdominal pain, vomiting, fatigue and dark-red urine 2 hours after taking 2 spoons of Shidudan (containing about lead powder 4 g and Pb3O4 8 g) mistakenly. Two days later, the patient′ symptoms mentioned above became serious and developed scleral and mucocutaneous yellow staining. The laboratory tests showed the following results: blood lead level 8.38 μmol/L, hemoglobin (Hb) 89 g/L, alanine aminotransferase (ALT) 4 707U/L, aspartate aminotransferase (AST) 5 363U/L, lactate dehydrogenase (LDH) 2 988U/L, total bilirubin (TBil) 371.4 μmol/L, direct bilirubin (DBil) 184.30 μmol/L and indirect bilirubin (IBil) 187.1 μmol/L, urine lead level 4.87 μmol/L, urinary red blood cells (+ + ), urinary bilirubin (+ + ), urobi-linogen (+ + + ). Her urine was brown in color. The patient was diagnosed as acute lead poisoning, acute toxic liver disease (severe), acute hemolysis, and severe hemolytic anemia. Thepatient received the com-bined treatments including plasmapheresis, eliminating lead by calcium disodium edetate, and infusion of red blood cell. Fifty-seven days later, the patient′ symptoms of jaundice in sclera, skin and mucosa, abdominal pain, and vomiting disappeared. Her urine became clear. The results of laboratory tests showed the following: blood lead level 0.75 μmol/L, Hb 112 g/L, ALT 32 U/L, AST 32 U/L, LDH 174 U/L, TBil 23.1 μmol/L, DBil 13.7 μmol/L, and IBil 9.4 μmol/L. Key words: Lead poisoning; Shidudan (湿毒丹)