title: Severe Abdominal Pain Caused by Lead Toxicity without Response to Oral Chelators: A Case Report.
abstract: A 19-year-old woman was referred to the Emergency Surgery Department with severe abdominal pain, icterus, and anemia. The patient's clinical and paraclinical findings in addition to her occupational and social history, convinced us to assay blood lead level (BLL), which was 41/5 μg/dL. Therefore toxicology consult was performed to treat lead toxicity. Recheck of the BLL showed the level as 53/7 μg/dL. So oral chelator with succimer was started. Despite consumption of oral chelator, there was no response and the pain continued. Because our repeated evaluations were negative, we decided to re-treat lead poisoning by intravenous and intramuscular chelators. Dimercaprol (BAL) + calcium EDTA was started, and after 5 days, the pain relieved dramatically and the patient was discharged. We recommend more liberal lead poisoning therapy in symptomatic patients, and also suggest parenteral chelator therapy, which is more potent, instead of oral chelators in patients with severe symptoms.
authors.affiliation: Associate Professor, Gastroenterology and Hepatology Department, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Vossoughinia
authors.affiliation: Gastroenterology Fellow, Department of Gastroenterology and Hepatology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Pourakbar
authors.affiliation: Assistant Professor of Occupational Medicine, Department of Occupational and Environmental Medicine, Mashhad University of Medical Science, Mashhad, Iran.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Esfandiari
authors.affiliation: Gastroenterology Fellow, Department of Gastroenterology and Hepatology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Sharifianrazavi
keywords: Abdominal Pain; Lead Toxicity; Oral Chelators