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Case  Report

Acute arsenic poisoning from realgar water: Case series from Guilin, China 

Yong-Fei Fu, Hong-Zhen Xu, Xin Long, Qian-Qian Liao, Hai-Ling Huang, Kun Deng, Yan-Juan Jiang, Guo-Rong Tang, Shu-Ping Tang, Jian Tang, and Dong Qin

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Volume 64 (2026) p. 312 - 317

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 64 – No. 6/2026 (312-317)

Acute arsenic poisoning from realgar water: Case series from Guilin, China 

Yong-Fei Fu¹*, Hong-Zhen Xu²*, Xin Long¹, Qian-Qian Liao², Hai-Ling Huang², Kun Deng³, Yan-Juan Jiang⁴, Guo-Rong Tang⁵, Shu-Ping Tang⁶, Jian Tang², and Dong Qin²

¹College of Pharmacy, Guilin Medical University, ²Department of Pharmacy, ³Department of Pediatrics, ⁴Department of Gastroenterology, Guilin People’s Hospital, ⁵Central Office, Guilin Center For Disease Control And Prevention, and ⁶Department of Pharmacy, Guilin Hospital of the Second Xiangya Hospital Central South University, Guilin, China
Background: The inappropriate use of Traditional Chinese Medicine (TCM) poses significant health risks. Realgar (As₄S₄), an arsenic-containing mineral traditionally consumed during China’s Dragon Boat Festival, may induce acute toxicity following ingestion.
Materials and methods: This case series describes 8 patients (age: 1 – 80 years), including 2 children, with clinically confirmed acute arsenic poisoning subsequent to Dragon Boat Festival ingestion of realgar-containing water. We systematically evaluated clinical manifestations, laboratory parameters, and environmental arsenic concentrations. Urinary arsenic quantification was performed in all cases, with intravenous 2,3-dimercaptopropane sulfonic acid (DMPS) sodium salt initiated as chelation therapy.
Results: All patients developed gastrointestinal manifestations (nausea, vomiting, and diarrhea) within 5 – 14 days post exposure, accompanied by biochemical evidence of hepatic dysfunction. Laboratory analyses confirmed elevated urinary arsenic concentrations (> 0.032 mg/L) and identified arsenic contamination in drinking water (> 0.01 mg/L), with both measures exceeding established safety thresholds. Multi-organ dysfunction syndrome (MODS) was observed in 3 patients. All cases demonstrated a favorable clinical response to intravenous DMPS sodium salt chelation therapy, achieving clinical improvements and subsequent discharge.
Conclusion: This case series documented acute arsenic toxicity secondary to realgar consumption in both adults and children. The findings underscore the critical need for targeted public health education initiatives and enhanced regulatory oversight regarding traditional medicinal practices, particularly during cultural festivals. Furthermore, they emphasize the necessity for heightened clinical vigilance in the prompt diagnosis and management of arsenic poisoning associated with traditional cultural practices.

*These authors contributed equally to this study.Correspondence to:
Dong Qin, BSc
or
Jian Tang, MSc
Department of Pharmacy
Guilin People’s Hospital
No. 12 Wenming Road
Xiangshan District, Guilin 541002, China
Email: [email protected]; [email protected]

Original

Effectiveness of tacrolimus in patients with lupus nephritis: A randomized controlled trials meta-analysis 

Dongming Wu, Jinli Dong, Ping Tan, and Cuiqing Zeng

###ENGLISH_ABSTRACT_LINK### ###FREE_ENGLISH_ARTICLE_DOWNLIAD_LINK###

Volume 106 (2026) p. 85 - 95

Abstract

Clinical Nephrology, Vol. 106 – No. 2/2026 (85-95)

Effectiveness of tacrolimus in patients with lupus nephritis: A randomized controlled trials meta-analysis 

Dongming Wu, Jinli Dong, Ping Tan, and Cuiqing Zeng

Nephrology and Rheumatology Department, Guangdong Provincial Hospital of Chinese Medicine Hainan Hospital, Haikou, Hainan, China
Objective: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of tacrolimus in the treatment of lupus nephritis (LN) by synthesizing data from randomized controlled trials (RCTs).
Materials and methods: A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science for RCTs involving tacrolimus in patients with LN, published up to October 31, 2024. Eligible studies compared tacrolimus-either as monotherapy or in combination with agents such as prednisolone or mycophenolate mofetil (MMF) to control treatments like placebo or cyclophosphamide. Two reviewers independently screened the studies, extracted data, and assessed methodological quality. Statistical analyses were performed using Review Manager 5.3 and Stata 15. Standardized mean differences (SMDs) were used for continuous outcomes, and relative risks (RRs) for dichotomous outcomes.
Results: Of the 484 records screened, 9 RCTs involving 1,187 patients met the inclusion criteria. Tacrolimus significantly reduced urine protein compared to MMF, placebo, and intravenous cyclophosphamide (SMD: –0.33, 95% CI: –0.48, –0.19, p < 0.0001). It also led to modest improvements in serum creatinine (SMD: 0.17, 95% CI: 0.03, 0.30, p = 0.01) and serum albumin (SMD: 0.19, 95% CI: 0.06, 0.31, p = 0.005). However, no significant differences were observed in SLE Disease Activity Index, proteinuria, or serum C3 levels (p > 0.05). Tacrolimus was associated with a slightly lower risk of adverse events, although the differences was not statistically significant (RR: 0.96, 95% CI: 0.86 – 1.07, p = 0.46). Sensitivity analyses indicated some instability in the results for urine protein and serum creatinine.
Conclusion: Tacrolimus appears effective in improving select renal biomarkers in patients with LN, particularly in reducing urine protein and improving serum creatinine and serum albumin levels. However, it showed no significant benefit in other clinical disease activity markers when compared to standard therapies. Although associated with a sightly lower incidence of adverse events, the overall quality of evidence was moderate to low. Further high-quality studies are warranted to confirm these findings.Correspondence to:
Cuiqing Zeng, BA
Nephrology and Rheumatology Department
Guangdong Provincial Hospital of Chinese Medicine Hainan Hospital
Haikou, Hainan, 570203, China
Email: [email protected]

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