The Answer // From page 7
The correct answer is B. The lead levels in serum and urine were tested (517 mcg/L, 0-400 mcg/L; 131.7 mcg/L, 0-70.38 mcg/L). A diagnosis of lead poisoning was made. Three days after chelation treatment, his ymptoms disappeared and did not recur in the follow-up. We carefully reviewed the patient’s history and found that he had been using jineijin, a traditional Chinese medicine (TCM) drug, which is
made with dried endothelium corneum gigeriae galli (Figure E), at about 500
g/month and squama mantis (a TCM drug, at less than 5 g/month) as dietary
supplements for 3 years. The level of lead in ground jineijin (Figure F, the drug
the patients consumed is mainly processed by mixing ground jineijin and honey;
Figure G, the deposit left after the elution of honey in Figure F is ground jineijin) and squama mantis was measured with inductively coupled plasma optical
emission spectrometry, which proved to be 3,389 mg/kg, much higher than the
maximal limit allowed for drinking water (less than 0.01 mg/kg). It is estimated
that the patient’s daily lead intake from ground jineijin and squama mantis approximated 50 mg/day (acceptable limit being 100-300 mcg/day)1 in the past 3
Jineijin has traditionally been used in China to alleviate nausea and vomiting. 2
With the rapid development of industry, heavy metal pollution of water and soil
has been a widespread problem. 3 Heavy metal enrichment may appear in poultry
exposed to environmental population. Therefore, the lead content of jineijin obtained from poultry with high levels of lead exposure can easily exceed maximum
acceptable limits. In this patient, long-term high-dosage consumption of jineijin
may have been the source of lead exposure. n
We thank Linshen Xie, MD, department of environmental health and occupational
diseases, No. 4 West China Teaching Hospital, Sichuan University, for offering some
clinical data. We thank the patient for giving permission to share his information.
1. National Research Council (US). Safe Drinking Water Committee. Drinking water and health. National
Academy Press. Washington, D.C. 1977;1:309.
2. State Administration of Traditional Chinese Medicine. Advanced Textbook on Traditional Chinese Medicine and Pharmacology. New World Press, Beijing. 1995. (vol. 2).
3. Hui Hu, Q.J., Kavan, P. A study of heavy metal pollution in China: Current status, pollution-control policies and countermeasures. Sustainability. 2014;6:5820-38.
This article has an accompanying continuing medical education activity, also
eligible for MOC credit, Learning objective: Upon completion of this examination,
successful learners will be able to identify the features of lead poisoning.