July, 2016/ Vol 4/Issue 7 ISSN- 2321-127X Case Report International Journal of Medical Research and Review Available online at: www.ijmrr.in 1115 | Page Missed a beat: Is it your Ayurvedic drug? Kavita S Joshi 1 , Gajanan A Panandikar 2 , Yogesh G Kuntalwad 3 , Smrati Bajpai 4 1 Dr Kavita S Joshi, Associate Professor, 2 Dr Gajanan A Panandikar, Senior Resident, 3 Dr Yogesh G Kuntalwad, Senior Resident, 4 Dr Smrati Bajpai, Assistant Professor. All are affiliated with Department of Medicine, Seth G S Medical College, Parel, Mumbai, India. Address for Correspondence: Dr. Kavita S Joshi, Associate Professor, Department of Medicine, Seth G S Medical College, Parel, Mumbai, India, Email: kavitajoshi@kem.edu .................................................................................................................................................................................................. Abstract 24 year male presented with watery diarrhoea, 10-15 episodes/day since 2 days, vomiting, abdominal pain and giddiness since 1 day. Patient was hypotensive and had bradycardia. Rest of systemic examination was normal. ECG showed junctional bradycardia. Serum electrolytes, creatinine, Thyroid Function Tests were within normal limits. Troponin T levels were normal. On enquiry, patient gave history of ingestion of ayurvedic drug. Tribhuvankirtiras and mahashankvati for 1 day prior to symptoms, for dyspepsia. Patient was started on inotropic support with fluid correction for hypotension. Clinical diagnosis of arsenic and aconite toxicity was made. The drug samples showed high levels of Arsenic and Mercury. Aconite level could not be done due to unavailability of resources. Diagnosis of drug induced aconite and arsenic toxicity was made. With discontinuation of ayurvedic drugs and supportive management, patient improved symptomatically within 3 days with restoration of normal sinus rhythm. Key words: Missed beat, junctional bradycardia, Ayurvedic drug, Tribhuvankirtiras. ................................................................................................................................................................................................ Introduction It is a common misconception that Ayurvedic medicines are safe and devoid of side effects [1, 2]. Ayurvedic medicines are used without prescription and regulation, as over the counter drugs [3]. The use of ayurvedic medicines is popular in India - and in recent times has become accepted in other countries. For example, a recent survey conducted by the NCCAM in the USA showed that about 751 000 people in the United States had ever used ayurvedic drugs and 154 000 people had used them within the past 12 months. Many ayurvedic preparations contain heavy metals like arsenic, mercury and also aconite. Incorrect dosage or formulation of these drugs can cause heavy metal toxicity, which can be life threatening leading to death [4]. This case highlights the importance of eliciting drug history in each patient and magnitude of complications of Ayurvedic medications, which is often neglected in clinical practice, and early diagnosis can help in appropriate management of toxicity in such cases. Case report A premorbidly healthy 24 year old male presented with complaints of loose motions, nausea and vomiting since 2 days, abdominal pain since 1 day, giddiness and blackout since 1 day. There was no history of palpitation, chest pain, fever, cough, reduced urine output, drug intoxication, addictions and no blood or mucus in stool. No history of similar episodes in the past. There was no family history of cardiac disease or sudden death. On thorough enquiry for any drug consumption repeatedly, patient gave history of consumption of some Ayurvedic medications for dyspepsia. The drug given was found to be Tribhuvankirti Ras and mahashankvati, which was sent for chemical analysis for heavy metals. Manuscript received 2 nd June 2016 Reviewed: 12 th June 2016 Author Corrected: 24 th June 2016 Accepted for Publication 7 th July 2016