pica and Chronic-Disease

Topics: Air Pollution; Bone and Bones; Child, Preschool; Chronic Disease; Dexamethasone; Dimercaprol; Edetic Acid; Globins; Humans; Hydro-Lyases; Infant; Infant, Newborn; Lead; Lead Poisoning; Mannitol; Nephritis; Paint; Penicillamine; Pica; Porphyrins; Spectrum Analysis; Time Factors; United Kingdom; Water Pollution

Pica is the compulsive consumption of non-nutritive substances, and this disorder may occur more frequently in dialysis patients. The purpose of our study was to determine the prevalence of pica and the associated demographic and metabolic characteristics.. Retrospective, cross-sectional analysis.. Hospital-based, outpatient, pediatric hemodialysis unit.. Eighty-seven pediatric patients on chronic dialysis therapy were interviewed. Sixty-seven patients were receiving hemodialysis, whereas the remaining 20 were maintained on peritoneal dialysis. The predominantly nonwhite (93%) patient population had a mean age of 17.2 ± 7.2 years. Dialysis efficiency, estimated by urea clearance per patient volume (Kt/V), averaged 1.5 ± 0.5.. Standard patient interview and documentation of laboratory and dialytic parameters.. Prevalence of pica and associated comorbid conditions.. The survey indicated that 46% of patients experienced pica, further divided into simple "ice" pica (34.5%) versus "hard" pica (12.6%). Hard pica included the consumption of chalk, starch, sugar, soap, sand, clay, Ajax cleanser, sponge, wood, and potting soil. Patients on hemodialysis were 8.3 times more likely to have hard pica compared with those on peritoneal dialysis. Greater than 5 years on dialysis was associated with a 3.2 odds ratio of having pica (P = .02). Anemia was the most significant morbid association, occurring at an odds ratio of 4.4 (P = .001) for all pica and 10.6 (P = .004) for hard pica.. Pica, therefore, is prevalent and potentially harmful, requiring further attention in the nutritional management of pediatric dialysis patients.

Topics: Adolescent; Anemia; Child; Chronic Disease; Cross-Sectional Studies; Female; Humans; Male; Nutrition Assessment; Odds Ratio; Peritoneal Dialysis; Pica; Prevalence; Renal Dialysis; Retrospective Studies; Urea; Young Adult

Pagophagia, or the practice of consuming ice, is a particular expression of the more general phenomenon of pica. Pagophagia is a complex behavioral phenomenon arising from the interplay of biochemical, hematological, psychological, and cultural factors. This compulsive dietary aberration is observed in many children and pregnant women worldwide. The authors report 3 cases of severe iron deficiency anemia with a serum ferritin level of 2-3 ng/mL, in which the patients were consuming 2 trays and many bags of ice per day. Following treatment with iron therapy, pagophagia spontaneously resolved within 2 weeks. It is a commonly missed problem. Pediatricians should be alert to this phenomena and its association with iron-deficiency anemia.

Topics: Adult; Anemia, Iron-Deficiency; Appetite; Child; Chronic Disease; Female; Humans; Ice; Iron; Male; Pica

Transdermal fentanyl is an opioid analgesic that is effective on chronic pain, and which appears to be advantageous due to several factors such as ease of administration, the relatively stable serum concentration and long dose intervals. Nevertheless, the danger of abuse and dependence exists among patients who are prescribed fentanyl patches. We present a case of transdermal fentanyl abuse, where the administration route of the drug was changed. Our patient, who had no history of substance abuse and who suffered from chronic nonmalignant pain, used the fentanyl transdermal patches as oral transmucosal medication, raising the dose by ten-fold. This abuse of the drug was only for analgesic purposes without seeking anxiolysis and/or euphoria. After treatment and progressive reduction of fentanyl, the patient remains in good condition, and is currently taking the initial dose of the drug transdermally, without having experienced any withdrawal symptoms.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Chronic Disease; Depressive Disorder; Drug Administration Schedule; Drug Therapy, Combination; Dysthymic Disorder; Female; Fentanyl; Fluoxetine; Greece; Humans; Mouth Mucosa; Pain; Pica; Polychondritis, Relapsing; Self Administration; Substance-Related Disorders

This article reports a typical case of subacute sclerosing panencephalitis (SSPE). The patient contracted measles as an infant during the 1989 to 1991 United States measles epidemic. At 4 1/2 years of age, he developed behavioral changes and quickly progressed through the typical clinical stages of SSPE. His EEG was characteristic. Serum and CSF measles immunoglobulin G were markedly elevated. He remains alive but is vegetative. To our knowledge, this is the first case of SSPE stemming from the 1989 to 1991 measles epidemic. Because infants--the group at highest risk to develop SSPE--were most severely affected by this measles outbreak, other cases of SSPE stemming from this epidemic may occur.

Topics: Brain; Child, Preschool; Chronic Disease; Disease Progression; Humans; Magnetic Resonance Imaging; Male; Measles; Movement Disorders; Persistent Vegetative State; Pica; Severity of Illness Index; Subacute Sclerosing Panencephalitis

Topics: Adult; Anemia, Aplastic; Chronic Disease; Dentifrices; Female; Fluoride Poisoning; Humans; Pica; Toothpastes

Topics: Air Pollutants; Brain Diseases; Child; Child, Preschool; Chronic Disease; Diagnosis, Differential; Environmental Pollutants; Food Contamination; Humans; Infant; Lead; Lead Poisoning; Pica

A diagnosis of chronic lead poisoning in a mentally retarded adult with pica was initially proposed because of the presence of a "lead line" on the patient's gingiva. The patient had no other signs or symptoms suggestive of her toxic state. Lead poisoning is reviewed from the standpoint of epidemiology, pathophysiology, clinical and oral manifestations, and diagnostic procedures. Dentists working with children or mentally retarded patients should be aware of the increased incidence of lead poisoning in these patient populations and the importance of oral findings and lead-screening techniques in the detection of lead poisoning.

Topics: Chronic Disease; Female; Gingival Diseases; Humans; Intellectual Disability; Lead Poisoning; Middle Aged; Pica; Pigmentation Disorders

Topics: Adolescent; Adult; Child; Child, Preschool; Chronic Disease; Growth; Humans; Pica; Sexual Maturation; Sulfates; Turkey; Zinc

Twenty-seven asymptomatic children with confirmed chronic increased lead absorption were compared with 27 matched control children for evidence of neuropsychological impairment. Evaluation of each child included a complete history, physical examination, quantitative neurological tests, and comprehensive psychological tests. There was significantly increased incidence of hyperactive behavior in the subjects with increased lead levels, but there was no significant difference in any of the quantitative test results. Uncontrolled variables, especially lead absorption in infancy and adverse environmental pressures other than lead, still leave questions about the relationship between chronic lead exposure and behavior of intelligence.

Topics: Chelating Agents; Child; Child, Preschool; Chronic Disease; Coproporphyrins; Feeding Behavior; Female; Humans; Hyperkinesis; Intellectual Disability; Lead; Lead Poisoning; Male; Medical History Taking; Neurologic Examination; Perceptual Disorders; Pica; Psychological Tests; Socioeconomic Factors; Urban Population; Wechsler Scales

Topics: Brain Damage, Chronic; Chelating Agents; Child, Preschool; Chronic Disease; Environmental Exposure; Female; Humans; Infant; Lead; Lead Poisoning; Male; Pica