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Lead poisoning; a neglected potential diagnosis in abdominal pain
Mahtab Shabani1, Seyed Kaveh Hadeiy2, Parinaz Parhizgar2
1Private Gastroentrologist, Tehran, Iran.
Insights
Lead poisoning can cause severe abdominal pain, especially in patients with a history of opium abuse. This study found a significant link between elevated blood lead levels and gastrointestinal symptoms, highlighting the need for considering lead toxicity in diagnosis.
Area of Science:
- Toxicology
- Gastroenterology
- Public Health
Background:
- Abdominal pain is a common yet challenging symptom, often masking underlying conditions like lead poisoning.
- Diagnosing lead poisoning can be difficult, particularly when gastrointestinal (GI) symptoms are the primary presentation.
Purpose of the Study:
- To determine the prevalence of abdominal pain in lead-intoxicated patients at Loghman Hakim Hospital.
- To investigate the association between lead toxicity and opiate use disorder in patients presenting with abdominal pain.
Main Methods:
- Patients with unexplained or treatment-resistant abdominal pain were enrolled between July 2017 and January 2018.
- Lead poisoning was defined as a blood lead level (BLL) ≥ 30 μg/dL with GI symptoms; opiate use was determined historically.
- Data were collected using a standardized tool to ensure uniform data acquisition.
Main Results:
- Of 125 admitted patients, 28 (22.4%) had BLLs > 30 μg/dL.
- Elevated BLLs significantly correlated with oral opium use/abuse (daily use > 2.75g) and a history of addiction exceeding 12 years.
- Lead toxicity was statistically linked to abdominal pain severity, constipation, and paresthesias. Associated laboratory findings included anemia, leukocytosis, and abnormal liver enzymes.
Conclusions:
- Lead toxicity should be considered in the differential diagnosis of severe, resistant abdominal pain in emergency departments (EDs) and GI clinics.
- A history of opium abuse is a critical factor suggesting the need to test for lead toxicity.
Background:
Abdominal pain may be a presenting symptom of lead poisoning and is often difficult to diagnose. This study aimed to determine the prevalence of abdominal pain in patients seen in the Laghman Hakim Hospital ED and GI clinic who were lead-intoxicated, with or without opiate use disorder.
Methods:
Between July 2017 and January 2018, patients seen in the ED and GI clinic of Loghman Hakim Hospital with unexplained abdominal pain or abdominal pain resistant to treatment were enrolled. Informed consent was obtained from potential enrollees. For standardization, a pre-designed data collection tool was developed for uniform data acquisition. Opiate use was determined historically. For this study, lead poisoning was defined as a blood lead level (BLL) greater than or equal to 30 μg/dL (1.45 μmol/L) with concomitant GI symptoms.
Results:
Of 125 patients admitted, 28 (22.4%) had BLLs higher than 30 μg/dL. None of the patients had signs and symptoms of opioid withdrawal syndrome during evaluation. Elevated BLLs were significantly correlated with oral opium use/abuse, history of addiction for over the preceding 12 years. The daily opium use was more than 2.75 g. There was a statistical correlation between lead toxicity and abdominal pain consistency and intensity, constipation, and paresthesias. Anemia, leukocytosis, and abnormal liver enzyme tests were laboratory findings associated with lead toxicity. Four patients died, one of whom was diagnosed with lead toxicity.
Conclusion:
Lead toxicity should be considered in the potential differential diagnosis of severe and resistant abdominal pain in patients referring to general EDs or GI clinics if a positive history of opium abuse exists.
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