Private Gastroentrologist, Tehran, Iran.
Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Gastroenterol. 2020 May 6;20(1):134. doi: 10.1186/s12876-020-01284-1.
Abdominal 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.
Between 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.
Of 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.
Lead 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.
腹痛可能是铅中毒的首发症状，且往往难以诊断。本研究旨在确定拉格曼哈基姆医院急诊室和胃肠科就诊的、有或无阿片类药物使用障碍的铅中毒患者中腹痛的患病率。
2017 年 7 月至 2018 年 1 月期间，我们招募了在拉格曼哈基姆医院急诊室和胃肠科就诊的、有不明原因腹痛或腹痛经治疗后仍未缓解的患者。向潜在入组者获得了知情同意。为了标准化，我们为统一数据采集开发了一个预先设计的数据收集工具。阿片类药物的使用是通过病史确定的。在本研究中，铅中毒定义为血铅水平（BLL）大于或等于 30μg/dL（1.45μmol/L）并伴有胃肠道症状。
在 125 名住院患者中，28 名（22.4%）的 BLL 高于 30μg/dL。在评估过程中，没有患者出现阿片类药物戒断综合征的迹象和症状。BLL 升高与口服鸦片使用/滥用、过去 12 年成瘾史显著相关。每天的鸦片用量超过 2.75g。铅中毒与腹痛的一致性和强度、便秘和感觉异常之间存在统计学相关性。贫血、白细胞增多和异常的肝功能检查结果是与铅中毒相关的实验室发现。4 名患者死亡，其中 1 名被诊断为铅中毒。
如果存在阿片类药物滥用的阳性病史，在一般急诊室或胃肠科就诊的、有严重和顽固腹痛的患者中，应考虑铅中毒作为潜在的鉴别诊断。
