pica and Kidney-Failure--Chronic

The authors describe a patient with chronic renal failure who developed intestinal obstruction from talcum powder pica. A literature review found 43 previously reported cases of surgical complications caused by various forms of pica. Most occurred in women, blacks, aborigines, children, or the mentally retarded--all groups in whom pica occurs more frequently than the general population. Intestinal obstruction was the most common clinical presentation and the ileum most often the site of obstruction reported at surgery. Perforation with peritonitis was the next most common presentation but three cases of colon perforation were diagnosed only at surgery or postmortem. Mixed pica (paper, plastic bags, cloth, string) seemed more likely to require surgery and to cause perforation. An accurate preoperative diagnosis was made most often when a history of pica was sought, and opacity on abdominal X rays correctly interpreted. These clues to pica as the underlying cause of abdominal complaints should not be neglected in patients who are members of the groups known to be at higher risk of this compulsive eating disorders.

Topics: Abdominal Pain; Adult; Colonic Diseases; Female; Humans; Intestinal Obstruction; Kidney Failure, Chronic; Kidney Transplantation; Pica

Severe metabolic alkalosis is rarely seen in end stage renal disease (ESRD) patients on long-term hemodialysis. This can be life threatening and mortality is exponentially increased when the pH exceeds 7.60. Persistent vomiting, ingestion of alkali for dyspepsia and pica behavior are all potential causes of such severe metabolic alkalosis. The prevalence of pica is increased in chronic kidney disease and ESRD patients, with ice being the most commonly ingested substance. It can cause a myriad of complications including death, but the diagnosis may be elusive unless the pica behavior is witnessed firsthand by others since patients do not typically disclose their behavior. We present the case of a hemodialysis patient with severe alkalemia, hypernatremia, and excessive interdialytic weight gains resulting in recurrent hospitalizations for fluid overload due to baking soda pica behavior.

Topics: Alkalosis; Humans; Kidney Failure, Chronic; Pica; Renal Dialysis; Sodium Bicarbonate

Pica could be strongly implicated in nutritional status of patients on dialysis; however, very scarce data are currently available. The objective of this study was to evaluate the prevalence of pica and its association with nutritional status in dialysis patients.. This is a cross-sectional study in a tertiary care teaching hospital. Four-hundred patients on dialysis, without previous pica diagnosis or transplant, pregnancy, mental illness, or infection, were included in the study. Pica, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was classified as no pica, ice pica, or hard pica. Dialysis Malnutrition Score, 24-hour dietary recall, and biochemical measurements were obtained from patients. As part of statistical analysis, point prevalence and 95% confidence interval of pica were calculated. Comparisons between groups were performed by means of analysis of variance, Kruskal-Wallis test, χ. Prevalence of pica was 42% (ice pica, 46%; soil, 29%; two substances, 14%; red brick, 5%; paper, 3%; soap, 2%; and cattle pasture, 1%). Comparing patients with pica (hard pica and ice pica) versus no pica, subjects with pica were of younger age (25 ± 7, 27 ± 9, 30 ± 11 years, respectively), were more frequently educated <9 years (57%, 46%, 30%, respectively), and had longer dialysis duration (36 ± 19, 32 ± 18, 27 ± 16 months, respectively). Patients with pica achieved the recommended calorie and macronutrients intake target less frequently than those without pica (40-64% vs. 66-77%, P <.05). Malnutrition was present in 74% of the whole sample: (1) 67% in no pica group, (2) 80% in ice pica group, and (3) 89% in hard pica group (P = .001). In the multivariate analysis (R. A worse nutritional status was observed in patients with pica, who additionally were younger, had lower educational level, longer dialysis duration, and worse macronutrient intake routine than patients without pica. Malnutrition, C-reactive protein, and lower educational level significantly predicted both ice and hard pica.

Topics: Adolescent; Adult; Age Factors; C-Reactive Protein; Cross-Sectional Studies; Educational Status; Energy Intake; Female; Humans; Ice; Kidney Failure, Chronic; Male; Malnutrition; Nutrients; Nutritional Status; Pica; Renal Dialysis; Soil; Young Adult

Topics: Adult; Alkalosis; Aspirin; Citrates; Drug Combinations; Female; Humans; Iron Deficiencies; Kidney Failure, Chronic; Pica; Renal Dialysis; Seizures; Sodium Bicarbonate

Topics: Alum Compounds; Calcium Sulfate; Causality; Diagnosis, Differential; Electrolytes; Female; Humans; Hyperkalemia; Hypokalemia; Kidney Failure, Chronic; Middle Aged; Pica; Renal Dialysis; Sodium Bicarbonate; Starch

Topics: Humans; Kidney Failure, Chronic; MEDLINE; Pica

Topics: Humans; Kidney Failure, Chronic; Pica; Sodium Bicarbonate; Water-Electrolyte Imbalance

Pathological tooth wear is an increasing problem affecting a significant proportion of the population. Although different wear mechanisms have been described, most reports in the literature concentrate on cases in which the predominant mechanisms were erosion and attrition. This article presents an unusual case of abrasive tooth wear caused by a sand eating habit which the patient had adopted as a child. Different causes of "abrasive" wear are discussed and the difficulties in management of this case are also presented.

Topics: Adult; Cardiovascular Diseases; Dental Care for Chronically Ill; Denture, Overlay; Female; Habits; Humans; Kidney Failure, Chronic; Pica; Self-Injurious Behavior; Silicon Dioxide; Tooth Abrasion; Vertical Dimension

Topics: Alkalosis; Female; Humans; Kidney Failure, Chronic; Middle Aged; Pica; Renal Dialysis; Sodium Bicarbonate

A male patient undergoing hemodialysis in whom the cause of severe hyperkalemia (more than 8 mmol/liter) was found to be an unusual pica is described. His pica consisted of ingestion of burnt match heads (cautopyreiophagia). The potassium content of his daily consumption of burnt matches added 80 mmol to his 45 mmol dietary potassium intake. Hypogeusia and hypozincemia were documented. Oral zinc supplementation (zinc sulfate 220 mg per day for 10 weeks) normalized his plasma zinc level and taste acuity. He abandoned his pica and his plasma potassium level dropped significantly to 5.5 to 6 mmol/liter. It is suggested that inquiry about pica should be part of the dietary history in patients with renal failure.

Topics: Adult; Humans; Hyperkalemia; Kidney Failure, Chronic; Male; Pica; Potassium; Renal Dialysis; Sulfates; Taste Disorders; Zinc; Zinc Sulfate

Topics: Anemia; Appetite; Child; Feeding and Eating Disorders; Female; Humans; Iron Deficiencies; Kidney Failure, Chronic; Male; Nutritional Physiological Phenomena; Pica; Renal Dialysis; Zinc

Geophagia has been associated with life-threatening hyperkalemia in five patients with chronic renal failure. All five patients were black and had been born in the southeastern United States. Four had had frequent hyperkalemia requiring at least one hospitalization, and two had had hyperkalemia with serum potassium concentration as high as 9.8 mEq/liter, resulting in cardiac arrest in one and paralysis, disorientation, and cardiac arrythmia in the other. Since riverbed clay contains as much as 100 mEq of potassium in 100 gm of clay, much of which is exchangeable at acid pH, the mechanism of geophagia-induced hyperkalemia appears to be the absorption of potassium released from clay after ingestion. After discontinuing geophagia, no new hyperkalemic episodes occurred in these patients.

Topics: Adult; Aged; Arrhythmias, Cardiac; Black People; Female; Heart Arrest; Humans; Hyperkalemia; Kidney Failure, Chronic; Male; Middle Aged; Paralysis; Pica; Potassium; Soil; United States