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 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 Can Be Easily Misdiagnosed as Acute Porphyria and Nonspecific Abdominal Pain

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ming-Ta Tsai ◽  
Shi-Yu Huang ◽  
Shih-Yu Cheng
Keyword(s):  
Abdominal Pain ◽  
Lead Poisoning ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Recurrent Abdominal Pain ◽  
Acute Porphyria ◽  
Detailed Medical History ◽  
History Of ◽  
Lead Levels ◽  
Test Result

Lead poisoning (LP) is less commonly encountered in emergency departments (ED). However, lead exposure still occurs, and new sources of poisoning have emerged. LP often goes unrecognized due to a low index of suspicion and nonspecific symptoms. We present a case of a 48-year-old man who had recurring abdominal pain with anemia that was misdiagnosed. His condition was initially diagnosed as nonspecific abdominal pain and acute porphyria. Acute porphyria-like symptoms with a positive urine porphyrin test result led to the misdiagnosis; testing for heme precursors in urine is the key to the differential diagnosis between LP and acute porphyria. The final definitive diagnosis of lead toxicity was confirmed based on high blood lead levels after detailed medical history taking. The lead poisoning was caused by traditional Chinese herbal pills. The abdominal pain disappeared after a course of chelating treatment. The triad for the diagnosis of lead poisoning should be a history of medicine intake, anemia with basophilic stippling, and recurrent abdominal pain.

Ceftriaxone-Induced Acute Pancreatitis

1993 ◽  
Vol 27 (1) ◽  
pp. 36-37 ◽  
Author(s):  
Anthony E. Zimmermann ◽  
Brian G. Katona ◽  
Joginder S. Jodhka ◽  
Richard B. Williams
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Signs And Symptoms ◽  
Etiologic Agent ◽  
Antibiotic Regimen ◽  
Intravenous Injections ◽  
Case Summary ◽  
Catheter Sepsis ◽  
History Of

OBJECTIVE: To report a case of probable ceftriaxone-induced acute pancreatitis. CASE SUMMARY: A patient with a history of short-bowel syndrome on home total parenteral nutrition developed fever, chills, and right flank pain. She was diagnosed with gram-negative catheter sepsis and prescribed antibiotic therapy to be administered for four weeks. After completion of the first week of therapy, the antibiotic regimen was changed to intravenous injections of ceftriaxone to be given daily at home. Prior to discharge the patient developed acute abdominal pain, leukocytosis, jaundice, and markedly elevated lipase and amylase concentrations consistent with acute pancreatitis. The patient's condition improved upon discontinuation of the ceftriaxone and the remainder of her stay was uneventful. DISCUSSION: There is only one other case report in the literature of probable ceftriaxone-induced pancreatitis. Multiple other medications have been implicated in causing acute pancreatitis. The exact mechanism of this uncommon adverse effect of ceftriaxone is unknown. CONCLUSIONS: There was a temporal relationship between the development of this patient's signs and symptoms and the administration of ceftriaxone. We could not identify any other factors that may have been responsible for the development of her acute pancreatitis. Ceftriaxone should be considered as a possible etiologic agent in patients who present with acute abdominal pain and elevated lipase and amylase concentrations.

scholarly journals Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting with Motor Neuropathy and Upper Limb Paresis: A case report

2019 ◽  
Vol 18 (4) ◽  
pp. 529 ◽  
Author(s):  
Seyed M. M. Mirzaei ◽  
Ayob Akbari ◽  
Omid Mehrpour ◽  
Nasim Zamani
Keyword(s):  
Nervous System ◽  
Case Report ◽  
Lead Poisoning ◽  
Chelation Therapy ◽  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Motor Neuropathy ◽  
Upper Limbs ◽  
Gastrointestinal Complications

Opium users may present with central or peripheral nervous system-related symptoms, gastrointestinal complications and anaemia; in such cases, lead poisoning should be suspected and chelation therapy initiated as soon as possible. We report a 64-year-old male patient with a 20-year history of opium addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with severe motor neuropathy and paresis in both upper limbs. His primary symptoms were generalised weakness, abdominal and bone pain, constipation and lower limb paraesthesia that had started several months prior. In addition, he reported severe progressive bilateral paresis of the upper limbs of one month’s duration. A diagnosis of lead poisoning was confirmed by a blood lead level of 140 μg/dL. The patient underwent chelation therapy after which he improved significantly. At a one-year follow-up visit, he was neurologically intact and symptom-free.Keywords: Opium Dependence; Lead Poisoning; Lead-Induced Nervous System Diseases; Paresthesia; Case Report; Iran.

scholarly journals Secondary lead poisoning a projectile housed in the human body

2012 ◽  
pp. 230-234 ◽  
Author(s):  
Juan Bernardo Gerstner Garcés
Keyword(s):  
Lead Poisoning ◽  
Human Body ◽  
Management Strategies ◽  
Signs And Symptoms ◽  
Gunshot Wounds ◽  
Neurological Status ◽  
Patient Knowledge ◽  
Unexplained Death ◽  
History Of

With the increase of violence and use of firearms in Colombia, we may see more cases of lead poisoning in our environment, and must be prepared to diagnose and treat them. Subtle signs and symptoms as unexplained anemia, gastro-intestinal discomfort and abdominal cramps, and severe as changes in behavior and neurological status, nephropathy, and unexplained death, may be associated with a history of gunshot wounds and projectiles in the human body, and must offer the patient knowledge and management strategies of pathology.

ID: 28: ACQUIRED IMMUNODEFICIENCY SYNDROME RELATED KAPOSI SARCOMA A RARE INTRUDER AFFECTING THE STOMACH

2016 ◽  
Vol 64 (4) ◽  
pp. 938.1-938
Author(s):  
N Vyas ◽  
H Alkhawam ◽  
S Ahmad ◽  
R Companioni ◽  
R Sogomonian ◽  
...  
Keyword(s):  
Gastric Ulcer ◽  
Abdominal Pain ◽  
Kaposi Sarcoma ◽  
Initial Presentation ◽  
Aids Patients ◽  
Diffuse Abdominal Pain ◽  
Gi Symptoms ◽  
Mucosal Involvement ◽  
History Of ◽  
Haart Therapy

IntroductionKaposi sarcoma (KS) is a vascular tumor that is commonly associated with human herpesvirus 8 (HHV-8). The epidemic type of KS is associated with the most common tumor arising in HIV infected people, which is considered by CDC guidelines an AIDS defining illness. Lesions on the skin are the most common initial presentation in patients unlike the involvement of visceral sites. We present a unique case of KS affecting the stomach, initially presenting as abdominal pain and diarrhea.CasePatient is a 34 year old female with past medical history of AIDS/HIV with a CD4 count of 143 cells/μL, VL 46 copies/mL on HAART therapy diagnosed with visceral and cutaneous manifestations presents to the ED with nausea, vomiting, diarrhea and diffuse abdominal pain for three days. The symptoms have progressively gotten worse. Patient denies any history of fevers, recent travel, sick contacts or recent antibiotic use. On examination, the patient had stable vitals and evidence of dark brown, papular skin lesions of various sizes over face, torso and upper extremity. Abdominal examination revealed tenderness in the epigastric area. Laboratory studies and initial abdominal cat-scan with contrast were unremarkable. All infectious workup was negative. However, EGD revealed esophageal nodule in the mid-distal esophagus (figure 1A), non-obstructive lower esophageal (LE) stricture (figure 1B), and a gastric ulcer raised with heaped margins (figure C). Biopsy of the gastric ulcer reveals KS with necrosis. Throughout hospital course, patient received 12 rounds of Doxirubicin for treatment, continued with HAART therapy. Patient is tolerating chemotherapy well, cutaneous lesions are improving and signs and symptoms of diarrhea and abdominal pain have alleviated.DiscussionCutaneous manifestation is usually the initial presentation of KS and visceral involvement is typically a later manifestation of disease. What is interesting in this case is the involvement of both cutaneous and visceral sites. It can be observed in the gastrointestinal (GI) tract, but rarely seen in the stomach. GI lesions may be asymptomatic or may cause weight loss, abdominal pain, nausea, vomiting and obstruction, which is seen in our case. EGD revealed distal LE stricture and gastric ulcer biopsy showing KS with necrosis. For AIDS patients who have KS, HAART therapy should be initiated to induce regression. For systemic treatment chemotherapy with Doxirubicin should be considered when there is symptomatic visceral or mucosal involvement and extensive cutaneous KS. We suggest the KS be included in the differential in AIDS patients with diarrhea and non-specific GI symptoms. Moreover, EGD should be considered for symptomatic patients because untreated GI KS includes hemorrhage and perforation.Abstract ID: 28 Figure 1

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

Treatment of adult lead poisoning with D-penicillamine

2019 ◽  
Vol 34 (2) ◽  
Author(s):  
Maryam Paeezi ◽  
Nasim Zamani ◽  
Hossein Hassanian-Moghaddam ◽  
Shahin Shadnia ◽  
Naghmeh Zamani ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
Day Treatment ◽  
Lead Level ◽  
Case Series ◽  
Blood Lead ◽  
Signs And Symptoms ◽  
Outpatient Setting ◽  
Treatment Protocols ◽  
Case Series Study ◽  
Significant Difference

Abstract Background The aim of the current study was to evaluate the efficacy of D-penicillamine in the treatment of lead poisoning mainly in the outpatient setting. Methods In a case series study performed during the recent epidemic of lead poisoning in Iran, lead-poisoned patients referring to our outpatient clinic were treated with 250-mg D-penicillamine capsules administered every 6 h for 5 or 10 days based on availability of the medication. They were recommended to re-check blood lead level (BLL) 4 weeks after cessation of the treatment and refer to our clinic again. Results In 63 patients with lead poisoning but without signs and symptoms of lead encephalopathy, median BLL was 106 [84, 131] μg/dL on presentation, which declined to a mean of 52.6 ± 28.8 μg/dL after a median treatment period of 7 [5, 10] days (p < 0.001). There was no statistically significant difference between the 5- and 10-day treatment protocols regarding complications and recovery. Treatment had resulted in a median decrease of 54 μg/dL [33, 90] (range: −20 to 231 μg/dL) in the patients’ BLLs (33.9% declined in BLL measurements; range: −29.69% to 99.06%). Conclusions D-penicillamine may be an acceptable substitute treatment in adult lead poisoning. Although our sample size was limited, we could not detect any serious adverse effects in our cases showing that D-penicillamine resulted in acceptable recovery rates. This may be helpful especially in epidemics with limitations in antidote access.

A Homeopathic Approach to Inflammatory Bowel Disease (Crohn’s and Colitis)

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
M.P Sharma
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Abdominal Pain ◽  
Crohn's Disease ◽  
Treatment Plan ◽  
Signs And Symptoms ◽  
Lifestyle Advice ◽  
History Of ◽  
Inflammatory Bowel ◽  
Positive Results

Homeopathy for Chrohn’s disease and colitis. “In clinical practice I have come across countless cases, in various stages of IBD and have had extremely positive results. The most useful tool in treatment is accurate case taking and history. Many patients typically ignore or neglect key symptoms that help accurately determine the most beneficial remedy or remedies for treatment. Proper administration of the treatment plan, nutritional, and lifestyle advice and patient compliance pay dividends in healing.”The first signs and symptoms of both Crohn's disease and UC are very similar. These symptoms include diarrhea, abdominal pain and cramping, rectal bleeding, fever, and fatigue. Both UC and Crohn's disease occur more commonly in people ages 15 to 35 and people with a family history of either type of IBD.

scholarly journals Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study

2021 ◽  
pp. archdischild-2021-322290
Author(s):  
Jordan E Roberts ◽  
Jeffrey I Campbell ◽  
Kimberlee Gauvreau ◽  
Gabriella S Lamb ◽  
Jane Newburger ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Oral Mucosa ◽  
Multivariable Analysis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Laboratory Findings ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Clinical Signs And Symptoms ◽  
Inflammatory Syndrome

ObjectiveFeatures of multisystem inflammatory syndrome in children (MIS-C) overlap with other febrile illnesses, hindering prompt and accurate diagnosis. The objectives of this study were to identify clinical and laboratory findings that distinguished MIS-C from febrile illnesses in which MIS-C was considered but ultimately excluded, and to examine the diseases that most often mimicked MIS-C in a tertiary medical centre.Study designWe identified all children hospitalised with fever who were evaluated for MIS-C at our centre and compared clinical signs and symptoms, SARS-CoV-2 status and laboratory studies between those with and without MIS-C. Multivariable logistic LASSO (least absolute shrinkage and selection operator) regression was used to identify the most discriminative presenting features of MIS-C.ResultsWe identified 50 confirmed MIS-C cases (MIS-C+) and 68 children evaluated for, but ultimately not diagnosed with, MIS-C (MIS-C-). In univariable analysis, conjunctivitis, abdominal pain, fatigue, hypoxaemia, tachypnoea and hypotension at presentation were significantly more common among MIS-C+ patients. MIS-C+ and MIS-C- patients had similar elevations in C-reactive protein (CRP), but were differentiated by thrombocytopenia, lymphopenia, and elevated ferritin, neutrophil/lymphocyte ratio, BNP and troponin. In multivariable analysis, predictors of MIS-C included age, neutrophil/lymphocyte ratio, platelets, conjunctivitis, oral mucosa changes, abdominal pain and hypotension.ConclusionsAmong hospitalised children undergoing evaluation for MIS-C, children with MIS-C were older, more likely to present with conjunctivitis, oral mucosa changes, abdominal pain and hypotension, and had higher neutrophil/lymphocyte ratios and lower platelet counts. These data may be helpful for discrimination of MIS-C from other febrile illnesses, including bacterial lymphadenitis and acute viral infection, with overlapping features.

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