Pica in an urban environment. In children under two years of age, mouthing objects—or putting small objects in their mouth—is a normal part of development, allowing the child to explore their senses. Treating this deficiency with medication or vitamins often resolves the problems. 1992 Mar;160:341–54. Khan Y, Tisman G. Pica in iron deficiency: a case series. The second is 15- year old African girl who presented with bleeding from the nose, habitual smelling of soil, consuming ice packs and chewing rubber bands. Pica in the geriatric mentally ill:  unrelenting and potentially fatal. There was no history of bleeding from the gums, easy bruising or familial bleeding disorders. Conclusion: The medical practice is full of challenges and complexity; and clinicians need to be vigilant all the time in their practice to appreciate unusual and rare manifestations of common clinical conditions like IDA and CD. Am J Med. It is commonly associated with other pica cravings [4-6], and has been mostly reported with iron and/or calcium deficiency [7-11] and thus, responds to treatment of underlying deficiency without any other intervention.In the present case, there was no other pica craving or iron and calcium deficiency. ** For children, anemia was defined as Hb <10.5 g/dL in children age 6 months-3 years, <12 g/dL in boys age 4 to 12 years and girls age 4 years and older, and <13g/dL in boys age 12 years and older. These two cases vary from the traditional presentation of pica by exhibiting an uncommon form of eating ice packs and even a rarer form of chewing rubber bands. The condition is often associated with iron deficiency with the majority of cases responding well to iron replacement [9]. Washington DC, London England: American Psychiatric Publishing; 2013. p. 329–31. It is the link between iron deficiency anemia and … Examination showed that she was pale with active bleeding from the nose. Those who are pregnant and craving nonfood items should only be diagnosed with pica when their cravings lead to ingesting nonfood items, and the ingestion of those items poses a potential medical risk (either due to the quantity or type of item being ingested). Our cases fuel the debate on the role of iron in the onset of pica. J Nutr. Pica anemia—an iron deficiency that can cause pica cravings Intestinal blockages or constipation as a result of objects that are difficult to digest, such as pebbles or metal Tears in the lining of the esophagus or intestines caused by hard or sharp objects, including paper clips or metal scraps Over the past two months she had progressively increased the habit of eating clay, cold drinks and ice packs: behaviour that was accompanied by dizziness and awareness of her heart beat. Clotting time was 5 minutes under simplate II technique skin bleeding. Interestingly, though, for our cases, the pica behaviour was noticed by caretakers who thought the behaviour had a medical significance and sought medical attention. Pica: symptom or eating disorder? Blood tests can also be done to test for anemia . There was a significantly higher prevalence of pica among patients homozygous for Hb S (Hb SS, sickle cell anemia) compared with the combined group of double heterozygous patients with Hb SC, Hb SD, and Hb Sβ thallasemia (Sβ + or Sβ 0) (35.6% vs 25.5%; P = .03). One study used a definition of anemia in children age 1–14 years as Hb <2 standard deviations below the mean, serum iron <9 ng/mL, or transferrin saturation under 12% (Ece et al. Pica. Diagnosing pica should be accompanied by tests for anemia, potential intestinal blockages, and toxic side effects of substances consumed (i.e., lead in paint, bacteria or parasites from dirt). Sodium chloride pica is a very rare form of pica [4]. Globally, this deficiency affects 9-16% of adult women (1). Pica may be benign, or it may have life-threatening consequences [1]. The definition is occasionally broadened to include the chewing non-nutritive substances. Pagophagia can occur alongside nutrient deficiencies, such as iron deficiency anemia, although it … Treating this deficiency with medication or vitamins often resolves the problems. Broadening the perspective of pica: literature review. Public Health Rep Wash DC 1974.1990 Feb;105(1):29–35. The pattern of menstrual bleeding was irregular, prolonged with up to 14 days period between cycles. Within genotype, mean Hb levels were significantly lower and reticulocyte counts were significantly higher in the patients with pica. This behaviour is linked to a condition called pica, where patients develop cravings for … Full blood count revealed normal platelet counts but the Hb was 6.8g/dl; the peripheral blood smear showed anisocytosis with pencil-shaped cells. The first-line treatment for pica involves testing for mineral or nutrient deficiencies and correcting those. The eating of these substances must be developmentally inappropriate. Pica symptoms usually go unnoticed until a physician inquires explicitly about them or when the associated complications occur [4]. ObstetGynecol.2003 Nov;102(5) Pt 2):1169–71. If the behaviors aren’t caused by malnutrition or don’t stop after nutritional treatment, a variety of behavioral interventions are available. A 25-year old female college graduate presented with a six-month history of abnormal uterine bleeding. 2008 Jul1;121(7):e1. Physical examination: a young female who was pale and wasted but fully conscious without jaundice or lower limb oedema. Symptoms. J Med Case Reports. The soil can be prepared by baking or frying, and the amount of dirt ingested ranges from 20-40g, and can range from consuming pieces of pottery, or eating beans that have a high concentration of dirt found in them (1). Pathogenesis of pica is not well understood through the risk factors are well documented. Up to one third of children ages 1 to 6 have these eating behaviors. Iron deficiency is usually considered a symptom rather than a cause. On arrival she had profuse bleeding that required etamsylate injection and adrenaline nasal pack. Introduction: Pica is a mysterious condition characterised by patients developing cravings for non- nutritive substances that may escalate into serious medical complications.We present two case reports with a somewhat unusual nature of presentation attributed to iron deficiency. Pica is the ingestion of nonfood items with wool sucking being a form of pica, in which the cat sucks on the material but may not ingest it. There’s no single cause of pica. However, the beginning of pica symptoms in our cases were preceded by a history blood loss and this may suggest otherwise. A craving to constantly chew on non-food or non-nutritive substances can be a sign of an eating disorder called pica. Download full-text PDF ... parameters diagnostic for iron deficiency anemia. Learn more about eating disorders statistics >. A plausible hypothesis regarding pica suggests that the appetite-regulating brain enzymes, being altered by an iron or zinc deficiency, trigger specific cravings. Br J Psychiatry J Ment Sci. A 34-year-old woman presented with iron deficiency anaemia refractory to treatment for more than a decade. Dumaguing NI, Singh I, Sethi M, Devanand DP. A 16-year-old school girl presented with a history of intermittent epistaxes. Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed. All patients met criteria for pica under the DSM-5 criteria [1] and they all responded well to treatment. The treatment continued for further two weeks by which time the Hb had risen to 11g/dl, and all the symptoms had subsided. Laboratory investigations: haemoglobin (Hb) was7.8g/dl. Thrombocytosis occurred only in women and was more prevalent in those with pica (20.4% vs. 8.3%; p = 0.0050). Pica & Severe Anemia Symptom Checker: Possible causes include Iron Deficiency. It is unclear how many people are affected by pica. Pica is seen more in young children than adults. Because pica can occur in people who have poor nutrition, the health care provider may test blood levels of iron and zinc. Both presented with haematological parameters diagnostic of iron deficiency anaemia. Mohave County US. 2005Feb;118(2):185–8. The clinical presentation of pica is highly variable and is associated with the specific nature of the resulting medical conditions and the ingested substances. We describe two patients who presented with a habit of ingesting non-nutritive substances which was associated with iron deficiency and blood loss. There are no laboratory tests for pica. Iron deficiency occurs when the levels of hemoglobin carried by the red blood cells are decreased. Anemia is defined as a decrease in hemoglobin or hematocrit levels below the 2.5th percentile for age, race, and sex. It most likely is more prevalent in developing countries. In: Diagnostic and statistical manual of mental disorders.5th edition. It is held that swallowing of ice cubes maybe explained by the analgesic properties of ice cubes to relieve glossal pain associated with iron deficiency but it is not clear why a patient would develop a preference substances that have no analgesic properties such as the rubber bands [9]. Even if you don’t have full-blown iron deficiency anemia, ... cause you to crave non-food items like paper, ice, dirt, chalk or clay! Her pica symptoms and anemia resolved fol- 2003 Sep 1;16(3):189–91. Pica is an eating disorder. Check the full list of possible causes and conditions now! In many cases, concerning eating behaviors disappear as deficiencies are corrected. Pica is typically defined as the persistent ingestion of non-nutritive substances for at least one month at an age when this behaviour is developmentally inappropriate. It might also be a sign that something in your body is out of balance. A lesson on pica. An unusual but completely reversible form of pica in the form obsessive compulsive sponge eating (pervasive disorder) was reported as an odd manifestation of IDA and CD. We are convinced that pica is an important pointer to iron deficiency and clinicians should suspect occult blood loss in a patient presenting with pica symptoms. Abdominal ultrasound and stool analysis was done from a collection of a freshly voided stool which was then processed using direct technique (saline and iodine mounts) to identify intestinal parasites about which all the findings were all unremarkable. The prevalence and type of pica depend on ethnic and cultural factors that affect dietary practices . BioScience.1978 Mar1;28(3):171–7. Typical substances ingested tend to vary with age and availability. Iron Deficiency Anemia and Pica Iron deficiency anemia is the most common nutrient deficiency worldwide. Find out what is the full meaning of PICA on Abbreviations.com! The systemic examination was normal except for a blood pressure of 170/100 and an ejection systolic murmur. Pica has been practiced for centuries without a clear etiology. Pagophagia is a form of pica that involves craving and compulsively consuming ice. Coltman described a form of pica, compulsive ice eat- ing, that he called pagophagia.4 In double-blind studies, he found that iron-deficient ice eaters lost their craving for ice approximately 2 weeks after iron supplemen- tation. A high sodium diet increases risk for nephrolithiasis. 1994 Jun;124(6 Suppl):954S–962S. It is proposed that the pica behaviour is possibly a mechanism to compensate for a nutritional deficiency. [cited2016 Oct 9]. All vital signs were stable. Most of these items include some type of clay in them, wh… Consent: Written informed consent was obtained from the patients. Statistics & Research on Eating Disorders, Other Specified Feeding or Eating Disorder (OSFED), Avoidant Restrictive Food Intake Disorder (ARFID). We present two case reports with a somewhat unusual nature of presentation attributed to iron deficiency. Khoushabi F, Ahmadi P, Shadan MR, Heydari A, Miri A, Jamnejad M. Pica practices among pregnant women are associated with lower hemoglobin levels and pregnancy outcome. Anemia, especially iron-deficiency anemia, is one of the known causes for this eating disorder. Iron-deficiency anemia and malnutrition are two of the most common causes of pica, followed by pregnancy. This is seen as bizarre eating disorder, and many are now asking questions about the causes, the symptoms and, eventually, the treatment. Infants and children diagnosed with pica … Medical problems including nutritional deficiencies, diseases of the GI, oral, metabolic, and central nervous systems as well as restrictive diets, electrolyte imbalances, toxins, and conditions leading to polyphagia should be ruled out but are uncommon. It is one of the best place for finding expanded names. Iron deficiency anemia is a common finding in women of child-bearing age. Talk … Both our patients responded well to managing the primary cause of blood loss and iron supplementation. Edwards CH, Johnson AA, Knight EM, Oyemade UJ, Cole OJ, Westney OE, et al. She reported a history of periodic dizziness with an episode of fainting. And while we know anemia can cause a host of symptom s, pica isn’t often usually on our radar. Over the course of these symptoms she had uncharacteristically been fond of the smell of soil and consuming ice packs followed by chewing rubber bands. The rest of the systemic examination and mental status evaluation were unremarkable. Mouthing may sometimes result in ingestion. Pica is simply a symptom that your body is trying to fix the deficiency (although … Pica can also occur during pregnancy. Pica and food craving in patients with iron-deficiency anemia: a case-control study in France. Lacey EP. Pica can affect children, adolescents, and adults of any genders. Kettaneh A, Eclache V, Fain O, Sontag C, Uzan M, Carbillon L, et al. 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