Abstract
BackgroundAbdominal 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.MethodsBetween 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.ResultsOf 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.ConclusionLead 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.
Highlights
Abdominal pain may be a presenting symptom of lead poisoning and is often difficult to diagnose
Patients evaluated in the emergency and GI outpatient clinic with the chief complaint of abdominal pain of unknown origin were enrolled into the study
One of whom was diagnosed with lead poisoning and had died due to aspiration pneumonia
Summary
Abdominal pain may be a presenting symptom of lead poisoning and is often difficult to diagnose. Abdominal pain has a diverse diagnostic schema, which ranges from mild self-limiting conditions to life-threatening emergencies. It is believed 20–40% of abdominal pain etiologies remain unknown at the time of discharge [2]. During the difficult time of an endemic or epidemic, premature closure of a diagnosis is exacerbated by anchoring, the tendency for clinicians to stick with the initial impression even as new information becomes available. Because of the broad differential diagnosis of abdominal pain, misdiagnosis may be minimized by a formalized approach. Anchoring is exacerbated during times such as the opium endemic in Iran. In order to avoid this diagnostic misadventure, clinicians must keep
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