{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:47:00Z","timestamp":1787237220108,"version":"build-2736575974"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:p>Rasa Karpura (RK) is an ayurvedic remedy used in India but not regulated by the Food and Drug Administration (FDA), and contains multiple compounds, such as mercury sulfide. We present the case of a 5-month-old girl who was given RK for constipation. At the emergency department (ED), she presented in acute distress, with tachycardia, tachypnea, altered mental status, and hematemesis. She required intubation for airway protection and, subsequently, was admitted to the pediatric intensive care unit (PICU). Laboratories revealed acute kidney and liver injury, for which continuous renal replacement therapy (CRRT) was initiated. Serum mercury concentration from the patient\u2019s initial presentation returned on day 3 of hospitalization at 3534\u00a0ug\/L (reference value \u226410\u00a0ug\/L). Chelation therapy with 2,3-dimercaptosuccinic acid (DMSA) was initiated. Mercury levels decreased significantly over hospitalization, and she was extubated on hospital day 12, transferred out of the PICU on hospital day 24, and discharged after 37\u00a0days. Her serum mercury concentration was 10.5\u00a0ug\/L at 196\u00a0days, and she received outpatient DMSA chelation. Our case describes the effects and management of mercury toxicity in a pediatric patient because of RK. Additional parental education on non-FDA-regulated remedies, such as ayurvedic medicines, is needed.<\/jats:p>","DOI":"10.1542\/peds.2025-071611","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:03:01Z","timestamp":1759795381000},"source":"Crossref","is-referenced-by-count":2,"title":["The Ayurvedic Remedy Rasa Karpura and a Case of Inorganic Mercury Toxicity"],"prefix":"10.1542","volume":"156","author":[{"given":"Hector D.","family":"Barreto-Vazquez","sequence":"first","affiliation":[{"name":"1Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Rees","sequence":"additional","affiliation":[{"name":"1Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabana","family":"Yusuf","sequence":"additional","affiliation":[{"name":"1Baylor College of Medicine, Houston, Texas"},{"name":"2Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Harding","sequence":"additional","affiliation":[{"name":"1Baylor College of Medicine, Houston, Texas"},{"name":"2Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle P.","family":"Suen","sequence":"additional","affiliation":[{"name":"1Baylor College of Medicine, Houston, Texas"},{"name":"2Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"2025103119570685600_r1","doi-asserted-by":"crossref","first-page":"376327","DOI":"10.1155\/2013\/376327","article-title":"Indian traditional ayurvedic system of medicine and nutritional supplementation","volume":"2013","author":"Pandey","year":"2013","journal-title":"Evid Based Complement Alternat Med."},{"key":"2025103119570685600_r2","article-title":"FDA warns about heavy metal poisoning associated with certain unapproved ayurvedic drug products | FDA","author":"US Food and Drug Administration"},{"issue":"8","key":"2025103119570685600_r3","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1001\/jama.300.8.915","article-title":"Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet","volume":"300","author":"Saper","year":"2008","journal-title":"JAMA."},{"issue":"4","key":"2025103119570685600_r4","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1179\/2049396715Y.0000000009","article-title":"A cluster of lead poisoning among consumers of Ayurvedic medicine","volume":"21","author":"Breeher","year":"2015","journal-title":"Int J Occup Environ Health."},{"issue":"3","key":"2025103119570685600_r5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/10773525.2018.1447880","article-title":"Toxic metals in ayurvedic preparations from a public health lead poisoning cluster investigation","volume":"23","author":"Mikulski","year":"2017","journal-title":"Int J Occup Environ Health."},{"key":"2025103119570685600_r6","first-page":"3726","article-title":"Karpura Rasa- a herbo-mineral formulation review","author":"Kamath","year":"2020","journal-title":"IAMJ."},{"issue":"4","key":"2025103119570685600_r7","first-page":"160","article-title":"Review on classical preparation methods of Rasakarpura","volume":"2","author":"Mehta","year":"2013","journal-title":"AAM."},{"key":"2025103119570685600_r8","article-title":"Karpura Rasa - 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