Treatment of adult lead poisoning with D-penicillamine

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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Section: Introductionmentioning

confidence: 99%

Lead poisoning; a neglected potential diagnosis in abdominal pain

Shabani¹,

Hadeiy

Parhizgar

et al. 2020

BMC Gastroenterol

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“…The higher number of male patients compared to the females seems a predictable finding as males are more engaged in high-risk occupations, use opium more commonly, and are more prone to be environmentally exposed to lead 14 . However, almost one-fifth of our patients were females.…”

Section: Discussionmentioning

confidence: 99%

“…Heroin and Iranian crack samples had 48.8 μg/g and 30.8 μg/g lead, respectively. This was again an endemic problem in Iran until 2016 when an epidemic of lead poisoning due to lead-contaminated opium peaked 14 . Studies during this period mentioned the possibility of existence of more than 42,000 lead-poisoned patients 15 .…”

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confidence: 99%

A Preliminary Report on the Largest Ongoing Outbreak of Lead Toxicity in Iran

Zamani

Mehrpour

Hassanian‐Moghaddam

et al. 2020

Sci Rep

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no countrywide data exists on the patients' characteristics of lead exposure in iran. We aimed to evaluate the demographic characteristics and blood lead level (BLL) of these patients in the country scale during five consecutive years, including the epidemic outbreak year (2016). Between 2014 and 2018, records of all patients who had referred to two reference laboratories in Tehran, Iran, to check BLL were evaluated. Of 58,642 patients, 48,589 were male. Mean age was 44.9 ± 20.7 years. Males had higher BLLs and were significantly older. Median BLL was 16 µg/dL (0.3 to 263 µg/dL). Median BLL was significantly higher in 45-to 60-year-old patients. The highest median BLL was reported in May 2016 confirming our records about the peak of the epidemic. Although the frequency of high BLL declined after 2016, it never returned to the measures before that. Considering the ongoing high prevalence of increased BLLs after 2016 and similar environmental and occupational exposures as before, lead-contaminated opium still seems to persist in the Iranian opium black market. Substitution of this lead-contaminated opium by opioid Maintenance therapy (oMt)-prescribed opium tincture is recommended.

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“…Treatment of lead poisoning is centered on prevention, eliminating lead exposure, proper diet (rich in calcium and iron), education, and if indicated, treatment using chelating agents including (dimercaprol (BAL), calcium disodium ethylenediaminetetraacetic acid (CaNa2 EDTA), succimer (DMSA,2-3 mesodimercaptosuccinic acid), and D-penicillamine) [8,9]. Prevalence of lead poisoning has dropped over the recent years because of the lead safety and preventive measures and programs [10] although epidemics of lead poisoning due to adulterated opium or herbal medicine were recently reported worldwide [11,12].…”

Section: Introductionmentioning

confidence: 99%

Lead Poisoning; a Neglected Potential Diagnosis in Abdominal Pain

Shabani

Hadeiy

Parhizgar

et al. 2020

Preprint

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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.

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Treatment of adult lead poisoning with D-penicillamine

Cited by 15 publications

References 5 publications

Lead poisoning; a neglected potential diagnosis in abdominal pain

Lead poisoning; a neglected potential diagnosis in abdominal pain

A Preliminary Report on the Largest Ongoing Outbreak of Lead Toxicity in Iran

Lead Poisoning; a Neglected Potential Diagnosis in Abdominal Pain

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