1482 Chalk Eating: A Culturally-Accepted Form of Pica in Georgia?

Abstract

INTRODUCTION: Pica is the persistent intake of nonnutritive and nonfood substances seen commonly in children, pregnant women, institutionalized persons, patients with developmental disabilities and iron deficiency. Kaolin ingestion in the form of chalk, white dirt or white clay, is a lesser known form of pica but a common occurrence in Central Georgia. We present a case of a young black female from Georgia who presented with a partial bowel obstruction from eating chalk. CASE DESCRIPTION/METHODS: A 35-year-old black female from Augusta Georgia with iron deficiency anemia and depression presented with worsening abdominal pain, distention and constipation with the last bowel movement 2 weeks prior to presentation. She ate 5 lbs of chalk with each meal for the previous 10 years, like her mother. Her cravings for chalk increased with worsening anemia. Physical exam was pertinent for abdominal distention and tenderness. Laboratory tests revealed iron deficiency anemia but normal calcium and vitamin D level. The abdominal x-ray showed radiopaque material opacifying the lumen of the colon with nonobstructive bowel gas pattern. Flexible sigmoidoscopy was performed for mechanical disimpaction using endoscopic accessories was unsuccessful. Gastrograffin enema was then performed twice with resulting bowel movements. The patient received intravenous iron therapy and was evaluated by psychiatry. She was discharged home on iron supplements and laxatives. DISCUSSION: Kaolin is a soft white clay and an important ingredient in making porcelain, paper and rubber. It is not absorbed systemically but acts locally in the intestines where it adsorbs toxins and is used as an anti-diarrheal agent. The prevalence of kaolin ingestion especially among black female residents in Central Georgia represents a cultural-bound syndrome shared by family members or friends such as in our patient. Although our patient had iron deficiency anemia which could be associated with pica, the cultural practice of eating chalk is widely accepted in their community and believed that ingesting chalk helps with nausea, indigestion, and even constipation! Complications from this form of pica include anemia, malnutrition, constipation, intestinal obstruction, and even colon perforation. Management include medical, endoscopic or surgical removal of these substances and most importantly cognitive behavioral treatment. It is important to have a high index of suspicion for pica when multiple opacities are noted in the colon especially among residents of Georgia.