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Abstract
There is substantial overlap between the symptoms of gastroparesis and a variety of alternative disorders. These conditions include rumination syndrome, drug-induced gastric emptying delay, cannabinoid hyperemesis syndrome, and eating disorders, which can be identified based on the history alone. The remaining patients require a diagnostic approach of physical examination, laboratory tests, evaluation with esophagogastroduodenoscopy or contrast radiography, and a test to measure gastric emptying. Symptomatic patients who have normal nutritional status and gastric emptying that is either normal or mildly delayed should be diagnosed with functional dyspepsia, whereas patients with moderate or severe gastric emptying delay are diagnosed with gastroparesis.
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Affiliation(s)
- Lawrence A Szarka
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Michael Camilleri
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Kesavadev J, Saboo B, Sadikot S, Das AK, Joshi S, Chawla R, Thacker H, Shankar A, Ramachandran L, Kalra S. Unproven Therapies for Diabetes and Their Implications. Adv Ther 2017; 34:60-77. [PMID: 27864668 PMCID: PMC5216071 DOI: 10.1007/s12325-016-0439-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 12/11/2022]
Abstract
Diabetes is a chronic disease and is one of the leading causes of morbidity and mortality worldwide. Being an ancient disease, many individuals follow complementary and alternative medicinal (CAM) therapies for either the cure or prevention of the disease. The popularity of these practices among the general public is in no way a testimony to their safety and efficacy. Due to the possibility of undesirable interactions with conventional medicines, it is imperative that patients are asked about CAM use during patient assessment. Patient- and physician-targeted awareness programs on various aspects of CAM use must be initiated to create a better understanding of evidence-based use of these practices. In addition, there should be guidelines in place based on clinical trial outcomes, and stricter regulations need to be enforced on CAM practices to ensure their safety and effectiveness.
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Affiliation(s)
| | - Banshi Saboo
- Dia Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Shaukat Sadikot
- Department of Endocrinology/Diabetology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shashank Joshi
- Department of Diabetology, Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Hemant Thacker
- Department of Endocrinology, Bhatia Hospital, Mumbai, India
| | - Arun Shankar
- Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharati Hospital, Karnal, Haryana, India
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3
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Sardesai VM, Myers T. Clinincal Observations: Nutrient Supplements in Clinical Care. Nutr Clin Pract 2016. [DOI: 10.1177/088453360101600108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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4
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Liepa G. Editorial: Cardioprotective Effects of ω-3 Fatty Acids: A Critical Review That Should Be Read by a Wide Range of Health Professionals. Nutr Clin Pract 2016. [DOI: 10.1177/088453360101600102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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5
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Desai A, Staszewski H. Ayurvedic remedy for diabetes as a cause of lead poisoning: a case report. Am J Med 2012; 125:e3-4. [PMID: 22795818 DOI: 10.1016/j.amjmed.2012.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 04/07/2012] [Indexed: 11/26/2022]
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Sabatini-Sáez I, Guerra-Velásquez M, Reyna-Villasmil E, Mejía-Montilla J, Reyna-Villasmil N, Torres-Cepeda D, Delgado-Delgado O, Santos-Bolívar J. Lípidos y lipoproteínas en pacientes menopáusicas tratadas con diosgenina. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2009. [DOI: 10.1016/j.gine.2008.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Abstract
Drug-induced hepatotoxicity is underreported and underestimated in the United States. It is an important cause of acute liver failure. Common classes of drugs causing drug-induced hepatotoxicity include antibiotics, lipid lowering agents, oral hypoglycemics, psychotropics, antiretrovirals, acetaminophen, and complementary and alternative medications. Hepatotoxic drugs often have a signature or pattern of liver injury including patterns of liver test abnormalities, latency of symptom onset, presence or absence of immune hypersensitivity, and the course of the reaction after drug withdrawal.
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García Carrasco C, Muñoz Díaz F, Arranz Carrero AM, de Dios Arrebola García J, Magro Ledesma D. [Lead poisoning as a cause of abdominal pain]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:618-9. [PMID: 18028859 DOI: 10.1157/13112590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wong HHL, Smith RG. Patterns of Complementary and Alternative Medical Therapy Use in Children Diagnosed with Autism Spectrum Disorders. J Autism Dev Disord 2006; 36:901-9. [PMID: 16897395 DOI: 10.1007/s10803-006-0131-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Previous studies suggest that complementary and alternative medical (CAM) therapy use in children with chronic illnesses is higher than in children in the general population. In this study, we investigated patterns of CAM therapy use in children diagnosed with autism spectrum disorders (ASD, n = 50) as compared to a control population of children with no ASD (n = 50). Over half of the parents in the ASD group reported using, or had used at least one CAM therapy for their child (52%) as compared to 28% of the control group (P = 0.024). Seventy percent of therapies used in the ASD group were biologically based therapies comprised of special diets or supplements, and parents felt that 75% of the therapies used were beneficial.
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Affiliation(s)
- Helen H L Wong
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
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Lynch E, Braithwaite R. A review of the clinical and toxicological aspects of 'traditional' (herbal) medicines adulterated with heavy metals. Expert Opin Drug Saf 2006; 4:769-78. [PMID: 16011453 DOI: 10.1517/14740338.4.4.769] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The popularity of traditional remedies has greatly increased in westernised countries over recent years. Although many of these remedies are used safely, there have recently been an increasing number of case reports being published of heavy metal poisoning after the use of traditional remedies, in particular, Indian Ayurvedic remedies. This study reviews the data on published cases, along with the history of Ayurvedic medicine in an attempt to provide an insight into why heavy metals, in particular lead, mercury and arsenic are added in such large concentrations to these remedies.
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Affiliation(s)
- Emma Lynch
- Sandwell and West Birmingham NHS Trust, Regional Laboratory for Toxicology, City Hospital, Birmingham, B18 7QH, UK
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11
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Wang W, Duan B, Xu H, Xu L, Xu TL. Calcium-permeable acid-sensing ion channel is a molecular target of the neurotoxic metal ion lead. J Biol Chem 2005; 281:2497-505. [PMID: 16319075 DOI: 10.1074/jbc.m507123200] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acid-sensing ion channels (ASICs) are emerging as fundamental players in the regulation of neural plasticity and in pathological conditions. Here we showed that lead (Pb2+), a well known neurotoxic metal ion, reversibly and concentration-dependently inhibited ASIC currents in the acutely dissociated spinal dorsal horn and hippocampal CA1 neurons of rats. In vitro expression of ASIC subunits in combination demonstrated that both ASIC1 and -3 subunits were sensitive to Pb2+. Mechanistically, Pb2+ reduced the pH sensitivity of ASICs independent of membrane voltage change. Moreover, Pb2+ inhibited the ASIC-mediated membrane depolarization and the elevation of intracellular Ca2+ concentration. In addition, we compared the effect of Pb2+ with that of Ca2+ or amiloride to explore the possible interactions of Pb2+ and Ca2+ in regulating ASICs, and we found that Pb2+ inhibited ASIC currents independent of the amiloride/Ca2+ blockade. Because ASIC1b and -3 subunits are mainly expressed in peripheral neurons, our data identified ASIC1a-containing Ca2+-permeable ASIC as a novel central target of Pb2+ action, which may contribute to Pb2+ neurotoxicity.
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Affiliation(s)
- Wei Wang
- Institute of Neuroscience and Key Laboratory of Neurobiology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031
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Hyodo I, Eguchi K, Nishina T, Endo H, Tanimizu M, Mikami I, Takashima S, Imanishi J. Perceptions and attitudes of clinical oncologists on complementary and alternative medicine: a nationwide survey in Japan. Cancer 2003; 97:2861-8. [PMID: 12767101 DOI: 10.1002/cncr.11402] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prevalence of complementary and alternative medicine (CAM) is increasing worldwide because of the growing public interest in natural or holistic therapies and because of the flow of information through the Internet. However, there is a lack of communication between cancer patients and their physicians on topics relating to CAM. The authors performed a cross-sectional survey to evaluate the perceptions and attitudes of Japanese clinical oncologists toward cancer CAM. METHODS The CAM questionnaires were sent to 2118 clinical oncologists. The questionnaires gathered data on background (age, gender, years in practice, specialty, and knowledge of cancer CAM), perception (effectiveness/ineffectiveness, scientific evidence, and drug interactions), and attitude (experience with and response to CAM users). Questions about oncologists' perceptions and attitudes to CAM were limited to herbs and other natural products that were sold over the counter. RESULTS One hundred sixty-six questionnaires were returned as undeliverable. Of the remaining questionnaires, 751 were returned (a response rate of 39%). Two-thirds of the responders were surgical oncologists and most of the remaining responders were medical oncologists. The majority of oncologists (82%) believed that CAM products were ineffective against cancer. The main reason for this belief was a lack of reliable information (as cited by 85% of oncologists). Only 13% of oncologists had experienced CAM-associated disease improvement in their cancer patients. Of all the oncologists, 84% considered the possibility of drug interactions between anticancer drugs and CAM products. The majority of oncologists (80%) replied that they could neither promote the use of CAM products nor recommend quitting the products, when they were asked about the use of CAM products by cancer patients. CONCLUSIONS Negative perceptions of CAM products persist among clinical oncologists. A lack of proven effectiveness of CAM products and concerns about drug interactions with anticancer treatment suggest a need for both accurate information on CAM products and clinical trials.
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Affiliation(s)
- Ichinosuke Hyodo
- Department of Medical Oncology, National Shikoku Cancer Center, Ehime, Japan.
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Sardesai VM. Herbal medicines: poisons or potions? THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2002; 139:343-8. [PMID: 12066132 DOI: 10.1067/mlc.2002.124582] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Vishwanath M Sardesai
- Department of Surgery, School of Medicine, University Health Center, Detroit, MI 48201, USA.
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Leung JM, Dzankic S, Manku K, Yuan S. The prevalence and predictors of the use of alternative medicine in presurgical patients in five California hospitals. Anesth Analg 2001; 93:1062-8. [PMID: 11574384 DOI: 10.1097/00000539-200110000-00053] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We measured the prevalence and predictors of the use of alternative medicine supplements in surgical patients by way of a self-administered questionnaire in consecutive patients > or = 18 yr old awaiting elective noncardiac surgery at five San Francisco Bay Area Hospitals. A total of 2560 patients completed the study survey (60% response rate). Of these patients, 39.2% admitted to using some form of alternative medicine supplements, of which herbal medicine was the most common type (67.6%). Of those who admitted to taking alternative medicine supplements, 44.4% did not consult with their primary physicians, and 56.4% did not inform the anesthesiologists before surgery regarding their use of these products; 53% of the patients ceased the use of these products before surgery. Multivariate logistic regression analysis revealed the following variables to be associated with the preoperative use of herbal medicine: female sex (odds radio [OR] 1.42, confidence interval [CI] 1.17-1.72), age 35-49 yr (OR 1.25, CI 1.02-1.53), higher income levels (OR 1.85, CI 1.50-2.27), Caucasian race (OR 1.34, CI 1.07-1.67), higher level of education (OR 1.35, CI 1.10-1.65), problems with sleep (OR 1.32, CI 1.05-1.66), problems with joints or back (OR 1.27, CI 1.04-1.56), allergies (OR 1.48, CI 1.21-1.82), problems with addiction (OR 1.90, CI 1.25-2.89), and a history of general surgery (OR 1.25, CI 1.03-1.52). In contrast, diabetes mellitus (OR 0.55, CI 0.36-0.86) and the use of antithrombotic medications (OR 0.57, CI 0.38-0.87) were associated with decreased odds of the use of herbal medicines. We concluded that the use of alternative medicine supplements by surgical patients is prevalent. Documentation of the use of these products is critical to determine the potential of drug or anesthetic interactions in the perioperative period. IMPLICATIONS The use of alternative medicine supplements by presurgical patients is prevalent. Documentation of the use of these products is critical to determine the potential of drug or anesthetic interactions in the perioperative period.
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Affiliation(s)
- J M Leung
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA.
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Mamet R, Sztern M, Rachmel A, Stahl B, Flusser D, Schoenfeld N. Lead Poisoning: A New Biochemical Perspective on the Differentiation Between Acquired and Hereditary Neuroporphyria. Clin Chem 2001. [DOI: 10.1093/clinchem/47.9.1710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Rivka Mamet
- Porphyria Reference Laboratory, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel 49100
| | - Mario Sztern
- Emergency Department, Sapir Medical Center, Kfar Saba, Israel 44281
| | - Avinoam Rachmel
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tiqva, Israel 49202
| | - Bracha Stahl
- Drug Information Center, Rabin Medical Center, Beilinson Campus, Israel 49100
| | - Daniel Flusser
- Department of Medicine D, Soroka University Hospital and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel 84101
| | - Nili Schoenfeld
- Porphyria Reference Laboratory, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel 49100
- Department of Clinical Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 69978
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16
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Abstract
The safety of herbal remedies and supplement use is of particular concern in patients with renal disease, and reliable information is not always easy to find. Predialysis patients may be drawn to complementary and alternative medicine (CAM) because they believe it can help prevent the progression of their renal disease. The purpose of this series of articles on alternative medicine for nephrologists is to address concerns and issues specific to CAM use in dialysis patients and to provide a guide to reliable sources of information. This introductory article emphasizes safety issues with a focus primarily on herbal medicine. Lack of regulation means that patients may not actually be taking what they think they are. Independent laboratory analyses have shown a lack of stated label ingredients and many instances of supplements and traditional remedies being contaminated with pesticides, poisonous plants, heavy metals, or conventional drugs. While certain supplements are always unsafe (carcinogenic, hepatotoxic, glandular extracts), others are specifically contraindicated in renal disease. Supplement use may be especially hazardous in renal disease because of unpredictable pharmacokinetics, drug interactions, negative effects on kidney function, nephrotoxicity, hemodynamic alterations, unpredictable effects on blood pressure or blood glucose, or potentiation of electrolyte abnormalities. There are no data on potential dialyzability of either active compounds, or their potentially active or toxic metabolites. Many supplements contain metal ions and other minerals. Transplant recipients are also at risk from potential unpredictable effects on immune function. Recommendations and information resources are listed.
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Affiliation(s)
- N V Dahl
- Department of Medicine, Nephrology Division, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA.
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Radimer KL, Subar AF, Thompson FE. Nonvitamin, nonmineral dietary supplements: issues and findings from NHANES III. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2000; 100:447-54. [PMID: 10767902 DOI: 10.1016/s0002-8223(00)00137-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Commission on Dietary Supplement Labels encourages nutrition professionals to become knowledgeable about all dietary supplements. The Dietary Supplement Health and Education Act of 1995 (DSHEA) expanded the definition of dietary supplements beyond essential nutrients while distinguishing them from drugs or food additives. In order to give practical advice to consumers and policymakers, dietetics professionals need to understand the implications resulting from this less-restrictive regulatory environment for supplements. Dietetics professionals must also become familiar with claims made by manufacturers, retailers, and others regarding popular nonvitamin, nonmineral (NVNM) supplements, as well as usage prevalence and trends. However, NVNM supplements currently are classified inconsistently, and information on the prevalence of use is limited. Sales data suggest that total intake is increasing, and garlic and ginseng are consistently among the most popular supplements. Reported use of NVNM supplements in the third National Health and Nutrition Examination Survey was highest for garlic and lecithin. The data suggest associations of NVNM supplement use with age and more healthful lifestyles; however, there is also a reported link with higher alcohol consumption and obesity. Associations with education, income, region, and urbanization are not evident from the sales data. Standardized survey procedures regarding question phraseology, referent time period, and supplement categorization--along with use of representative samples--will improve our ability to assess supplement use, prevalence, and trends.
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Affiliation(s)
- K L Radimer
- Applied Research Program, National Cancer Institute, Bethesda, MD 20892-7344, USA
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Abstract
Abdominal pain is a common complaint with diverse etiologies. We describe an unusual case of recurrent abdominal pain in an adult due to lead poisoning, a condition usually associated with childhood. A previously healthy 42-yr-old man presented with 2 days of severe crampy abdominal pain and a 1-month history of constipation. Physical examination was remarkable for diffuse abdominal pain but peritoneal signs were not present. Blood tests were remarkable for hematocrit of 33 and mean cell volume of 78, with ovalocytes and basophilic stippling on blood smear. Abdominal x-ray showed stool throughout the colon and a nonspecific bowel gas pattern. The patient was treated with intravenous fluids and enemas, and his symptoms resolved within 2 days. Repeat history taking revealed he had been stripping paint from an old Victorian house in the preceding few months. He was discharged after a blood lead level was obtained. Before his clinic appointment he was readmitted 2 days later with recurrent abdominal pain. His blood lead level was elevated at 110 microg/dl (toxic range). After consultation with the Occupational Health and Safety Administration and local poison control service, he was treated with intravenous calcium edetate disodium and intramuscular dimercaprol. He was asymptomatic at discharge, with a level of 56 microg/dl. Two weeks later, a repeat level was elevated at 72 microg/dl, for which he received a 3-wk course of oral dimercaptosuccimer. Subsequent levels were unremarkable, and the patient remains asymptomatic. Abdominal pain secondary to lead poisoning in adults is uncommon. This case highlights the importance of taking a detailed occupational history and appropriately using "routine" blood tests to diagnose a rare condition that presented with a common complaint.
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Affiliation(s)
- K Jongnarangsin
- Department of Medicine, Bassett Hospital, Cooperstown, New York 13326, USA
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