1Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3Department of Preventive and Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده
Gastrointestinal (GI) manifestations of lead poisoning include abdominal pain, constipation, and diarrhea. Depending on the severity of a symptom, surgical consultation is required. The present study aimed to make a comparison between the mean blood lead levels of patients hospitalized for lead toxicity and the various Gl symptoms. A retrospective cross-sectional study was performed in 2020 at Khorshid Hospital, the main regional referral center for poisoned patients (Isfahan, Iran). A total of 82 patients aged ≥18 years who were hospitalized for lead poisoning during 2017-2018 were included in the study. Patients’ information was extracted from hospital medical records, including demographic information, clinical manifestations, blood lead levels, and treatment outcome. The mean age of the patients was 48.18±11.9 years, 91.5% were men, and 62.2% suffered from multiple GI symptoms, with abdominal pain being predominant (31.7%). Blood lead levels in patients with multiple GI symptoms were higher than those with only one symptom (P=0.01). Surgical consultation was required in 14.6% of the patients. Multiple GI symptoms were the main predictive factor for blood lead levels above 70 mg/dL (P=0.03, Odds ratio=3.06, 95% CI=1.09-8.61). Given the prevalence of abdominal pain and its association with elevated blood lead levels, differential diagnosis of abdominal pain should include lead toxicity.
Zajac L, Kobrosly RW, Ericson B, Caravanos J, Landrigan PJ, Riederer AM. Probabilistic estimates of prenatal lead exposure at 195 toxic hotspots in low- and middle-income countries. Environ Res. 2020;183:109251. doi: 10.1016/j.envres.2020.109251. PubMed PMID: 32311907; PubMed Central PMCID: PMCPMC7176741.
Force USPST, Curry SJ, Krist AH, Owens DK, Barry MJ, Cabana M, et al. Screening for Elevated Blood Lead Levels in Children and Pregnant Women: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321:1502-9. doi: 10.1001/jama.2019.3326. PubMed PMID: 30990556.
Wong J, Bourke E, Roberts V, Lim SM, Johnson D, Hamblin PS, et al. Lead poisoning associated with illicit opium use. Intern Med J. 2020;50:239-42. doi: 10.1111/imj.14729. PubMed PMID: 32037702.
Mostafazadeh B, Shadnia S, Tavakkoli MA, Khoddami Vishteh HR. Evaluation of blood lead level in methamphetamine users in Tehran. Subst Abuse Treat Prev Policy. 2017;12:2. doi: 10.1186/s13011-017-0088-3. PubMed PMID: 28222753; PubMed Central PMCID: PMCPMC5320762.
O’Connor D, Hou D, Ok YS, Lanphear BP. The effects of iniquitous lead exposure on health. Nature Sustainability. 2020;3:77-9. doi: 10.1038/s41893-020-0475-z.
O’Connor D, Hou D, Ye J, Zhang Y, Ok YS, Song Y, et al. Lead-based paint remains a major public health concern: A critical review of global production, trade, use, exposure, health risk, and implications. Environ Int. 2018;121:85-101. doi: 10.1016/j.envint.2018.08.052. PubMed PMID: 30179767.
Mitra P, Sharma S, Purohit P, Sharma P. Clinical and molecular aspects of lead toxicity: An update. Crit Rev Clin Lab Sci. 2017;54:506-28. doi: 10.1080/10408363.2017.1408562. PubMed PMID: 29214886.
Vahabzadeh M, Megarbane B. Abdominal pain related to adulterated opium: An emerging issue in drug addicts. World J Psychiatry. 2020;10:95-100. doi: 10.5498/wjp.v10.i5.95. PubMed PMID: 32477905; PubMed Central PMCID: PMCPMC7243618.
Shah Farhat A, Khademi G. Blood lead level and seizure: a narrative review. Reviews in Clinical Medicine. 2015;2:84-7.
Doodkanloy Milan F, Torabi M, Mirzaee M. The relationship between blood lead level and the severity of abdominal pain in opioid-addicted patients during a hospital outbreak. J Addict Dis. 2018;37:211-6. doi: 10.1080/10550887.2019.1663088. PubMed PMID: 31580206.
Beigmohammadi MT, Aghdashi M, Najafi A, Mojtahedzadeh M, Karvandian K. Quadriplegia due to lead-contaminated opium--case report. Middle East J Anaesthesiol. 2008;19:1411-6. PubMed PMID: 18942257.
Shabani M, Hadeiy SK, Parhizgar P, Zamani N, Mehrad H, Hassanian-Moghaddam H, et al. Lead poisoning; a neglected potential diagnosis in abdominal pain. BMC Gastroenterol. 2020;20:134. doi: 10.1186/s12876-020-01284-1. PubMed PMID: 32375657; PubMed Central PMCID: PMCPMC7201765.
Hayatbakhsh Abbasi MM, Ansari M, Shahesmaeili A, Qaraie A. Lead serum levels in opium-dependent individuals. Addict Health. 2009;1:106-9. PubMed PMID: 24494092; PubMed Central PMCID: PMCPMC3905488.
