Lead encephalopathy in an adult opioid abuser

2021 ◽  
Vol 14 (9) ◽  
pp. e240977
Author(s):  
Fatima Suleman ◽  
Karima Shoukat ◽  
Ainan Arshad ◽  
Nadeem Ullah Khan ◽  
Usman Sheikh
Keyword(s):  
Abdominal Pain ◽  
Hospital Admissions ◽  
Lead Level ◽  
Lead Toxicity ◽  
Peripheral Blood Smear ◽  
Liver Function Tests ◽  
Altered Consciousness ◽  
Resource Limited ◽  
Lead Encephalopathy ◽  
Intravenous Calcium

A 38-year-old man presented at the emergency department with abdominal pain, vomiting, generalised weakness and altered consciousness. He had been ingesting opioids for over 5 years and had several past hospital admissions for abdominal pain. His investigations showed deranged liver function tests, anaemia and basophilic stippling on the peripheral blood smear. Further investigations revealed a significant increase in the serum lead level. We started chelation with peroral penicillamine 250 mg every 6 hours for 2 days and switched to intramuscular dimercaprol 4 mg/kg every 12 hours and intravenous calcium ethylenediamine tetraacetic acid 50 mg/kg in two divided doses daily for the next 5 days. We then discharged him home; he had become clinically stable by that time. We repeated his lead level and followed him up in the clinic. In this report, we emphasise the consideration of lead toxicity in opioid abusers and bring to attention a rare way of lead chelation in resource-limited settings.

scholarly journals Intravenous Calcium Gluconate Alleviates Lead-Induced Abdominal Pain, A Randomized Clinical Trial

2020 ◽  
Author(s):  
Masoud Mayel ◽  
Saleh Hamzeh ◽  
Salile Shahabi Shahabi Rabori ◽  
Sareh Ghasemirad ◽  
Nasim Zamani ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lead Poisoning ◽  
Calcium Gluconate ◽  
Conventional Treatment ◽  
Controlled Trial ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Saline Group ◽  
Group 2 ◽  
Intravenous Calcium

Abstract Background : In 2016, in a lead poisoning outbreak in Iran, physicians reported thousands of opium users who presented to emergency departments (EDs) with intractable severe abdominal pain which did not respond to any narcotic medication. During the same period of time, we investigated the efficacy of intravenous calcium gluconate in alleviating lead-induced abdominal pain. Methods: In a single-center, single blinded, randomized controlled trial, a convenient sample of adult opium-addicted patients who presented to an academic ED with abdominal pain and had an initial diagnosis of lead poisoning were included and randomly subjected to two treatment groups receiving conventional treatment (morphine 0.1 mg/kg + normal saline; group 1) and conventional treatment plus 1 gram of intravenous calcium gluconate (group 2) to alleviate their abdominal pain. The visual analogue scale (VAS) was determined by each patient (0 to 100 mm) before treatment, and 15, 30, and 60 minutes after intervention. Results: A total of 50 patients (25 in each group) were enrolled. Blood lead levels, VAS scores before treatment, and mean administered dose of morphine were similar between the two groups. After treatment, mean VAS score dropped to 64.7±10.4 vs. 67.1±10.9 at 15 minutes (P=0.437), 64.6±10.9 vs. 58.0±11.2 at 30 minutes (P= 0.041), and 63.8±10.7 vs. 53.6±10.9 at 60 minutes (P= 0.002) in groups 1 and 2, respectively. Conclusion: Intravenous calcium gluconate administration along with morphine can improve abdominal pain in lead poisoning due to the ingestion of lead-contaminated opium. Further interventional studies are recommended to see if response to calcium salts in suspected lead-induced abdominal pain can rule in lead toxicity. Trial registration: IRCT20171009036661N2. Registered 27 May 2018 - Retrospectively registered, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20171009036661N2

scholarly journals Intravenous Calcium Gluconate Alleviates Lead-Induced Abdominal Pain, A Randomized Clinical Trial

2020 ◽  
Author(s):  
Masoud Mayel ◽  
Saleh Hamzeh ◽  
Salile Shahabi Shahabi Rabori ◽  
Sareh Ghasemirad ◽  
Nasim Zamani ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lead Poisoning ◽  
Calcium Gluconate ◽  
Conventional Treatment ◽  
Controlled Trial ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Saline Group ◽  
Group 2 ◽  
Intravenous Calcium

Abstract Background : In 2016, in a lead poisoning outbreak in Iran, physicians reported thousands of opium users who presented to emergency departments (EDs) with intractable severe abdominal pain which did not respond to any narcotic medication. During the same period of time, we investigated the efficacy of intravenous calcium gluconate in alleviating lead-induced abdominal pain. Methods: In a single-center, single blinded, randomized controlled trial, a convenient sample of adult opium-addicted patients who presented to an academic ED with abdominal pain and had an initial diagnosis of lead poisoning were included and randomly subjected to two treatment groups receiving conventional treatment (morphine 0.1 mg/kg + normal saline; group 1) and conventional treatment plus 1 gram of intravenous calcium gluconate (group 2) to alleviate their abdominal pain. The visual analogue scale (VAS) was determined by each patient (0 to 100 mm) before treatment, and 15, 30, and 60 minutes after intervention. Results: A total of 50 patients (25 in each group) were enrolled. Blood lead levels, VAS scores before treatment, and mean administered dose of morphine were similar between the two groups. After treatment, mean VAS score dropped to 64.7±10.4 vs. 67.1±10.9 at 15 minutes (P=0.437), 64.6±10.9 vs. 58.0±11.2 at 30 minutes (P= 0.041), and 63.8±10.7 vs. 53.6±10.9 at 60 minutes (P= 0.002) in groups 1 and 2, respectively. Conclusion: Intravenous calcium gluconate administration along with morphine can improve abdominal pain in lead poisoning due to the ingestion of lead-contaminated opium. Further interventional studies are recommended to see if response to calcium salts in suspected lead-induced abdominal pain can rule in lead toxicity. Trial registration: IRCT20171009036661N2. Registered 27 May 2018 - Retrospectively registered, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20171009036661N2

scholarly journals Lead Poisoning; a Neglected Potential Diagnosis in Abdominal Pain

2019 ◽  
Author(s):  
Mahtab Shabani ◽  
Seyed Kaveh Hadeiy ◽  
Parinaz Parhizgar ◽  
Nasim Zamani ◽  
Hamid Mehrad ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lead Poisoning ◽  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Signs And Symptoms ◽  
Laboratory Findings ◽  
Opiate Use ◽  
History Of ◽  
Opium Use

Abstract Background Abdominal pain may be a presenting symptom of lead poisoning, and is often difficult to diagnose. We 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 micromoles/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 grams. 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.

scholarly journals Lead Poisoning; a Neglected Potential Diagnosis in Abdominal Pain

2020 ◽  
Author(s):  
Mahtab Shabani ◽  
Seyed Kaveh Hadeiy ◽  
Parinaz Parhizgar ◽  
Nasim Zamani ◽  
Hamid Mehrad ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lead Poisoning ◽  
Lead Level ◽  
Lead Toxicity ◽  
Signs And Symptoms ◽  
Laboratory Findings ◽  
Opiate Use ◽  
Gi Symptoms ◽  
History Of ◽  
Opium Use

Abstract Background: Abdominal pain may be a presenting symptom of lead poisoning, and poisoning and is often difficult to diagnose. This study We 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 micromoles/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 grams. 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.

scholarly journals Lead encephalopathy in adults

2014 ◽  
Vol 5 (02) ◽  
pp. 161-163 ◽  
Author(s):  
Janapareddy Vijaya Bhaskara Rao ◽  
Bhuma Vengamma ◽  
Thota Naveen ◽  
Vandanapu Naveen
Keyword(s):  
Health Hazard ◽  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Lentiform Nucleus ◽  
Abdominal Colic ◽  
Lead Encephalopathy ◽  
Lead Line ◽  
Management Issues

Lead poisoning is a common occupational health hazard in developing countries. We report the varied clinical presentation, diagnostic and management issues in two adult patients with lead encephalopathy. Both patients worked in a battery manufacturing unit. Both patients presented with seizures and one patient also complained of abdominal colic and vomiting. Both were anemic and a lead line was present. Blood lead level in both the patients was greater than 25 μg/dl. Magnetic resonance imaging of brain revealed bilateral symmetric involvement of the thalamus, lentiform nucleus in both patients and also the external capsules, sub-cortical white matter in one patient. All these changes, seen as hyperintensities in T2-weighted images suggested demyelination. They were advised avoidance of further exposure to lead and were treated with anti-epileptics; one patient also received D-penicillamine. They improved well on follow-up. Lead encephalopathy is an uncommon but important manifestation of lead toxicity in adults.

scholarly journals Acute lead poisoning: a diagnostic challenge in the emergency department

2021 ◽  
Vol 14 (1) ◽  
pp. e239740
Author(s):  
Bharath Gopinath ◽  
Vignan Kappagantu ◽  
Roshan Mathew ◽  
Nayer Jamshed
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Chelation Therapy ◽  
Acute Abdominal Pain ◽  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Diagnostic Challenge ◽  
Common Presentation ◽  
Life Threatening

Acute abdominal pain is a common presentation to the emergency department (ED). Ruling out life-threatening causes and giving pain relief are the most important tasks in ED. We describe a 32-year-old man who presented to ED with abdominal pain and vomiting which was unrelieved by usual doses of analgesic. Extensive investigations revealed no significant abnormalities. On further probing, he admitted taking traditional medications for infertility. The toxicological panel revealed a high blood lead level, leading to a diagnosis of acute lead toxicity. Chelation therapy with D-penicillamine was initiated and the patient’s abdominal pain resolved within 4 days.

Pyogenic Liver Abscess in Normal Children With Fever of Unknown Origin

PEDIATRICS ◽  
1976 ◽  
Vol 58 (4) ◽  
pp. 614-616 ◽  
Author(s):  
Sheldon L. Kaplan ◽  
Ralph D. Feigin
Keyword(s):  
Abdominal Pain ◽  
Liver Abscess ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Pyogenic Liver Abscess ◽  
Liver Function Tests ◽  
Blood Cultures ◽  
Normal Children ◽  
The Past ◽  
Liver Abscesses

Solitary pyogenic hepatic abscesses were identified as the cause of fever, abdominal pain, and hepatomegaly in two otherwise normal children who were seen at St. Louis Children's Hospital during the past year. Liver function tests were normal and blood cultures were negative in both patients. These cases illustrate that pyogenic liver abscess may occur in normal children and should be considered whenever fever of unknown origin is associated with abdominal complaints. Only in this way can we hope to improve upon the results cited previously, namely that the majority of liver abscesses remain undiagnosed during life.

scholarly journals Hyperthyroid Phase of Hashimoto's Thyroiditis

2019 ◽  
Vol 26 (1) ◽  
pp. 123
Author(s):  
Siti Nurul Hapsari ◽  
Sidarti Soehita
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Benign Lesion ◽  
Peripheral Blood Smear ◽  
Liver Function Tests ◽  
Hashimoto Thyroiditis ◽  
Ca 125 ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Function Tests ◽  
Chronic Autoimmune Thyroiditis ◽  
Function Tests

Hashimoto thyroiditis (chronic autoimmune thyroiditis) is the most common cause of hypothyroidism in iodine-sufficient areas of the world. This condition, however, can sometimes show hyperthyroidism. A 39-year-old femalewas admitted to hospital due to shortness of breath and tremor four hours before hospitalization. There were nausea, chestpain, cold chills, and palpitation. She was diagnosed with Hashimoto's thyroiditis and routinely received tyrosol,propranolol, and dexamethasone. Physical examination showed cervical mass, afebrile, blood pressure of 130/70 mmHg,pulse rate of 110 beats/minute and respiratory rate of 20 breaths/minute. Laboratory examinations showed WBC 7.53 x 109/L, Hb 11.0 g/dL and platelet count of 168 x 109/L. Chest X-Ray: negative for infiltrates. Several laboratory testswere performed, abnormal results were as follows: FT4 level of 2.96 ng/dL (increased), TSH level of 0.003 µIU/mL(decreased), anti-TPO (antithyroid microsomal antibody) level of 306 IU/ml (increased), and IgE level of 213.6 IU/mL(increased). Peripheral blood smear, coagulation test, serum electrolytes, liver function tests, renal function tests, urinalysis,CEA and Ca 125 were within normal limits. Thyroid ultrasound was performed and showed a benign lesion. Fine needleaspiration biopsy showed lymphocytic Hashimoto's thyroiditis. Echocardiography showed hyperthyroid heart disease. Dueto an increase of anti-TPO and FT4 levels, a decrease of TSH levels and lymphocytic thyroiditis from FNAB, this patient wasdiagnosed with a hyperthyroid phase of Hashimoto's thyroiditis. Thyroid function tests and thyroid antibody tests must bemonitored to distinguish between the hyperthyroid and hypothyroid phase of Hashimoto thyroiditis.

OUR SURGICAL EXPERIENCE IN ACUTE MESENTERIC ISCHEMIA- VARIOUS PATHOPHYSIOLGICAL TYPES – A CASE SERIES

2021 ◽  
pp. 25-29
Author(s):  
B. Santhi ◽  
A. Ramprasath ◽  
R. Saradha
Keyword(s):  
Abdominal Pain ◽  
Early Diagnosis ◽  
Elderly Patients ◽  
Mesenteric Ischemia ◽  
Hospital Admissions ◽  
Case Series ◽  
Arterial Occlusion ◽  
Acute Mesenteric Ischemia ◽  
Delayed Presentation ◽  
Surgical Critical Care

BACKGROUND: Mesenteric ischemia is a frequently lethal condition resulting from critically reduced perfusion to the gastrointestinal tract. It accounts for 1-2% of hospital admissions for abdominal pain. Mortality due to mesenteric ischemia ranges from 24% to 96% with an average of 69%. AIM: The aim of this case series is to outline the clinical presentation and challenges in diagnosis of acute mesenteric ischemia and emphasize the importance of early diagnosis and intervention in reducing the mortality and morbidity. This article presents a series of 4 cases of the 3 major types of acute mesenteric ischemia – 2 cases of Acute Mesenteric Arterial Thrombosis(AMAT), one case of Acute Mesenteric Arterial Embolism(AMAE) and one case of Mesenteric Venous Thrombosis(MVT). MATERIALS AND METHODS: A total number of 4 patients who had undergone emergency laparotomy for acute mesenteric ischemia during the month of December 2020 in the Department of General Surgery, Government Kilpauk Medical College were studied. All 4 cases have been analysed during this study period of one month and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. Out of 4 cases, 3 were cases of Superior Mesenteric Arterial Occlusion due to thrombus and emboli and 1 was a case of Superior Mesenteric Vein Occlusion by thrombus. All 4 were male patients. All 4 patients presented with sudden onset of abdominal pain with or without vomiting. Abdominal distension, constipation and clinical features suggestive of bowel gangrene was not seen in all cases. Out of 4 cases, 2 cases were diagnosed early and taken up for immediate surgery and had a better outcome postoperatively with shorter hospital stay. Denitive diagnosis could not be made at time of admission for one case and was taken up for surgery late after the general condition of the patient deteriorated and extensive gangrene of the small bowel was seen during surgery. One case succumbed to septic shock after surgery following delayed presentation. This case series attempts to highlight that the key to successful management in acute mesenteric ischemia is a high index of suspicion leading to early diagnosis, aggressive resuscitation and early mesenteric revascularization. CONCLUSION: Despite the remarkable advances in in vascular surgical technique, vascular imaging, percutaneous intervention and surgical critical care, mesenteric ischemia remains a complex and often disheartening disease. Acute mesenteric ischemia is a life threatening vascular emergency that requires a high degree of clinical suspicion and early intervention to avoid a poor outcome. As Acute Mesenteric Ischemia often affects elderly patients, we have to consider the possibility of acute mesenteric ischemia in all elderly patients presenting with abdominal pain that is out of proportion to the ndings on physical examination

Sign in / Sign up

Export Citation Format

Share Document