Mercury toxicity presenting as uncontrolled hypertension in two children due to the use of complementary and alternative medicine

Two children aged <5 years presented with paraesthesias, limb pain, behavioural disturbances, weight loss and poor sleep for 2.5 months and had hypertension on examination.Extensive evaluation for aetiologies of hypertension, including catecholamine-secreting and neural crest tumours, cardiac, endocrine and renal causes, was inconclusive.History subsequently revealed the use of alternative Indian medicine in both children. Heavy metal toxicity was suspected and was confirmed with elevated 24-hour urinary mercury levels. Both children responded well to chelation therapy with dimercaprol and had resolution of symptoms on follow-up.These two cases highlight that heavy metal toxicity in children is an evolving health concern of global importance. Hence, knowledge about the presence of heavy metals as an ingredient in some alternative medicines, seeking history about their usage and suspecting the varied clinical manifestations of heavy metal toxicity is essential while evaluating a child with uncontrolled hypertension.