Teen’s blood looked like ‘chocolate’ after healer’s kidney stone treatment, doctors say
.jpg "The blood of a 14-year-old boy (not pictured) was the color of chocolate after he was given a salt from a traditional healer in Pakistan, doctors said.")
For millennia, people have turned to traditional medicine and local healers for help with ailments from headaches to infectious disease.
The bark of willow trees, for example, was used as a pain reliever and anti-inflammatory by Sumerians and Egyptians 3,500 years ago, and is now the basis for aspirin, according to the World Health Organization.
Madagascar periwinkle, a plant native to the east Africa island nation, was first mentioned as a medicinal plant in Mesopotamian folklore, the WHO said. Today, active ingredients from the plant are used in childhood cancer drugs.
But, like any drug, chemical or medicine, natural remedies have to be used safely.
Now, a recent study offers a dire warning about the risks, examining the case of a boy in Pakistan who turned to a long-used traditional treatment — and was fighting for his life just hours later.
Doctors say he was accidentally poisoned.
The case
A 14-year-old boy was taken to the emergency room of a hospital in Lahore when his family noticed his nose, lips, cheeks, back, limbs and nail beds starting to turn blue in color, according to Sept. 11 case report in the Journal of Medical Case Reports.
The teen had a severe headache and was struggling to breathe, doctors said, and before reaching the hospital his family said he was agitated, drowsy and unable to follow instructions.
Hours before these severe symptoms began, the teen’s family told doctors he was having pain in his left side above his groin and felt a burning sensation while peeing, so they suspected he had a urinary tract infection or kidney stones, according to the report.
They took him to a traditional healer, who told the 14-year-old to take a tablespoon of kalmi shora, a potassium nitrate salt, meant to treat kidney stones, doctors said.
Two hours later, he was “delirious with an altered state of consciousness and showed extreme restlessness” in the hospital, according to the report.
The 14-year-old had an elevated heart rate at 113 beats per minute, lowering blood pressure and ”critically low” oxygen levels, doctors said.
Heart tests and chest X-rays were normal and toxicology of his urine ruled out any illicit drug use, according to the report.
Then, doctors took a blood sample from the boy, who was becoming hypothermic.
They noted the “peculiar appearance of the blood, resembling chocolate in color,” meaning blood in the arteries wasn’t carrying any oxygen, darkening from its red color to a deep brown.
Doctors diagnosed the teen with potassium nitrate-induced methemoglobinemia, or “blue baby syndrome,” caused by the traditional salts, according to the case report.
The diagnosis
Kalmi shora, also known as shora qalmi or potassium nitrate, is “an alkali mineral composed of potassium ions and nitrate ions having a sour taste,” according to a January 23 study published in the International Journal of Creative Research Thoughts.
“It is white (shiny) colored, odorless and has a hexagonal, crystal-like structure,” researchers said. “It gives (a) cooling sensation when put on (the) tongue.”
The salt is often used in Unani medicine, researchers said, a field of traditional medicine first developed by the ancient Greeks and later refined by Muslim scholars in South Asia, according to Britannica.
Traditional healers would give the salt in a powder form to treat anything from ulcers to fevers to gout, according to the study.
It is sometimes added to toothpaste to help with tooth sensitivity, or in meat preservatives to cause a reaction between myoglobin and hemoglobin in blood, helping the meat keep its red color, according to Britannica.
But, taken in high amounts, potassium nitrate is toxic to humans and can have deadly consequences.
For the 14-year-old boy, a tablespoon of kalmi shora powder was enough to trigger the serious blood condition methemoglobinemia, or MetHb.
“Methemoglobinemia (MetHb) is a very rare blood disorder, sometimes called ‘blue baby syndrome,’ which affects how red blood cells deliver oxygen to cells and tissues. People can inherit this condition but MetHb usually happens when people use certain medications or recreational drugs or exposure to certain chemicals,” according to the Cleveland Clinic.
The disorder also causes cyanosis, when there isn’t enough oxygen in the blood and the color darkens, giving skin, tongues, lips and nail beds a blue or purple color, the clinic says.
Luckily, the condition is treatable.
The teen was given a single dose of methylene blue, a drug designed to treat MetHb, along with a steroid and calcium supplement in saline, according to the case report.
In 10 minutes, the 14-year-old’s oxygen saturation levels were restored to normal levels, doctors said. In just 30 minutes, his bluish color had gone away.
The teen stayed at the hospital for two more days before he was discharged with multivitamins and a referral for the urology department to treat his kidney stones, according to the report. Doctors recommended the teen stop consuming any kalmi shora.
Is kalmi shora safe?
Potassium nitrate, sometimes called saltpeter, is more commonly used in products like fertilizer, pesticides, glass, fireworks, explosives and rocket fuel and can be dangerous externally, according to Britannica.
In preservatives, potassium nitrate is consumed in extremely small amounts, and helps keep things like bacon, ham, salami and some cheese from growing harmful bacteria, according to the BBC.
It is more often consumed in its natural form inside vegetables, which is safe, the outlet reports.
The salts are available online, including in the United States.
“The significance of considering traditional remedies as potential sources of toxicity cannot be understated. The ingestion of ‘kalmi shora’ in this case exemplifies the potential dangers with the unregulated use of herbal and traditional medications,” doctors said of the 14-year-old in Pakistan. “The case underscores the importance of educating patients about potential risks and seeking medical advice before utilizing such treatments.”
Lahore is in northeastern Pakistan near the northern border with India.
