CASE STUDY POISONING
BACKGROUND Lead poisoning was well known and documented since the early ages; in the first century AD, Pliny, the Roman author of the first encyclopedia, noted the toxic effects of lead. However, lead exposures still occur frequently because of its varied uses and persistence in the environment. Sources of lead include plumbing, pigments, pottery and plastics. The word ‘pica’ originated from the Latin word for ‘magpie’, because of its omnivorous habit and craving for unnatural articles of food. The term is currently used to describe cravings for unnatural food in humans. Medically it is a morbid craving, of longer duration, for undesirable particles such as earth, sand, coal, wallpaper, cloth, hair, paint, and even wood-lice. It has been reported from developing countries with prevalence varying from 10 to 32.5% of all children surveyed, and up to 73% of school children. It is even more prominent in younger children.
The condition has been hypothesized
to result from gastro-intestinal disturbances, nutritional deficiency, mental deficiency and neurosis. Simple habits are often responsible. Although no firm empirical data supports any of the nutritional deficiency etiologic hypotheses, deficiencies in iron, calcium, zinc, and other nutrients (eg, thiamine, niacin, vitamins C and D) have been associated with pica. Pica may be benign, or it may have life- threatening consequences; it has been shown to be a predisposing factor in accidental ingestion of infectious agents, soil-borne parasitic infections and poisons, particularly in lead poisoning. Sources of lead in this case are dirt, red lead in putty, and chips of lead- containing paint and lead containing cosmetics. The following are the clinical
presentations of two children (Pakistani sisters) with high blood lead levels possibly caused by pica, which were reported to the Health Authority – Abu Dhabi’s Poison and Drug Information center:
THE FIRST CHILD M A is a 2 year old female; she weighs 10.4kg with no medical history of any disease or taking any medication. Her mother reports that she eats sand, paint chips and is constantly putting objects in her mouth. A screening blood test for lead
evaluation found a level of (21.3 mcg/dL). The child has normal development (no neuro-developmental abnormalities). Her vital signs were the following:
Body temperature: 36.8C Respiratory rate: 20 Oxygen saturation in room air: 100% Lab studies (see table 1) were
consistent with iron deficiency anemia, for which the patient received iron treatment for one month and eventually anemia indicators improved.
THE SECOND CHILD A A is 3 years old, her body weight is 13.2kg and she was also reported by the mother to eat sand and paint chips. The child has no significant past medical history and is not taking any medication. A screening blood test for lead evaluation found a level of (11.2 mcg/dL). The child has normal development (no
neuro-developmental abnormalities). Her vital signs were the following:
Body temperature: 36.9C Respiratory rate: 26 Oxygen saturation in room air : 99% Lab tests (see table 2) were consistent
with iron deficiency anemia, for which she also received iron treatment for one month and all anemia indicators improved.
DISCUSSION Lead poisoning may present with non- specific symptoms such as anorexia, constipation, irritability, and anemia, or may be asymptomatic like in our cases. Chronic, unrecognized lead poisoning may lead to irreversible damage to the nervous system and kidneys. Although a blood lead level of greater than 10 mcg/dl is generally accepted as the threshold for concern, levels of less than 10 mcg/dl have been associated with intellectual impairment in children. Young children are one of the most vulnerable groups to the adverse effects of lead because of their rapidly developing central nervous
Arab Health Show Issue 2012 153
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