Document Type : Original Article

Authors

1 Department of Forensic Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

2 Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences

3 Department of Emergency Medicine , Hamadan University of Medical Sciences

Abstract

Background and Objective: Lead poisoning is a problem in Iranian society. The most common symptoms of chronic lead poisoning are abdominal pain, constipation, and dysphagia. In this study, the blood lead level (BLL) of the patients, who referred to Besat Hospital, Hamadan, Iran with non-traumatic abdominal pain was evaluated.
Materials and Methods: This is a case-control study in which 120 patients with abdominal pain, who referred to ED were divided into two groups. The first group of patients without exposure to lead (control) and the second group with exposure to lead (case), and then BLL were measured.
Results: Of 120 patients, 74 patients were male and 46 patients were female. The patients` mean age was 48.76 ± 17.12 years. The average BLL in the control group was 0.67 ± 1.38 μg/dL and in the case group was 1.61 ± 3.02 μg/dL (p<0.001). In the case group, 59 patients had a history of opium consumption and one was a building painter, whose average BLL was 1.63 ± 0.4 and 0 ± 0.3 μg/dL respectively. One patient from the control group and five patients from the case group had BLL higher than normal, but there was no statistical difference observed in both groups (p=0.207).
Conclusion: lead poisoning among patients with abdominal pain, especially in opium addicts, should always be considered as a differential diagnosis.

Keywords

1-Abdollahi M, Ebrahini-Mehr M, Nikfar S, Jalali N. Monitoring of lead poisoning in simple workers of a copying center by flame atomic absorption spectroscopy. MJIRI. 1996; 10(1):69-72.
2- Abdollahi M, Sadeghi Mojarad A, Jalali N. Lead toxicity in employees of a paint factory. MJIRI 1996; 10(3):203-6.
3-Abdollahi M, Shohrati M, Nikfar S, Jalali N. Monitoring of lead poisoning in bus drivers of Tehran. Irn J Med Sci. 1995; 20:29-33.
 4- Balali-Mood M, Shademanfar S, Moghadam JR, Afshari R, Ghassemi MN, Nemati HA, et al.Occupational lead poisoning in workers of traditional tile factories in Mashhad, Northeast of Iran.  International Journal of Occupational & Environmental Medicine. 2010; 1(1). PMID: 23022779
5- Malekirad AA, Oryan S, Fani A, Babapor V, Hashemi M, Baeeri M, et al. Study on clinical and biochemical toxicity biomarkers in a zinc-lead mine workers. Toxicology and industrial health. 2010; 26(6):331-7. PMID: 20371635 DOI: 10.1177/0748233710365697
6-Mehrpour O, Karrari P, Abdollahi M. Chronic lead poisoning in Iran; a silent disease. DARU Journal of pharmaceutical Sciences. 2012; 20(1):8. PMID: 23351197 DOI: 10.1186/2008-2231-20-8
7- Ghane T, Zamani N, Hassanian-Moghaddam H, Beyrami A, Noroozi A. Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016–2017. Bulletin of the World Health Organization. 2018; 96(3):165. PMID: 29531415 DOI: 10.2471/BLT.17.196287
8-Calello DP, Henretig FM. Goldfrank’s toxicologic emergencies.11th ed New York: McGraw-Hill, 2019.
9- Control CDC, Prevention. Blood lead levels in children aged 1-5 years-United States, 1999-2010. MMWR Morbidity and mortality weekly report. 2013; 62(13):245.
10- Domeneh BH, Tavakoli N, Jafari N. Blood lead level in opium dependents and its association with anemia: A cross-sectional study from the capital of Iran. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2014; 19(10):939. PMID: 25538776
11-Amiri M, Amini R. A Comparison of Blood-lead Level (BLL) in Opium-dependant Addicts with Healthy Control Group Using the Graphite Furnace/atomic Absorption Spectroscopy GF-  AAS) Followed by Chemometric Analysis.  Iran Red Crescent Med J 2012; 14:488–91. PMID: 23105986
12- Masoodi M, Zali MR, Ehsani-Ardakani MJ, Alizadeh AH, Aiassofi    K, Aghazadeh R. Abdominal pain due to lead-contaminated opium: a  new source of inorganic lead poisoning in Iran Arch Iran Med 2006 Jan;9(1):72-5. PMID: 16649384
13-Soltaninejad K, Faryadi M, Akhgari M. Determination of lead in opium by flame atomic absorption spectrometry method. Sci J Forensic Med 2003; 9:176-9.
14- Aghaee Afshar M, Khazaeli P, Behnam B, Rezazadehkermani M, Ashraf-Ganjooei N. Presence of Lead in Opium. Arch Iran Med 2008; 11:553–4.
15- Control CFD, Prevention. Blood lead levels in children aged 1-5 years-United States, 1999-2010. MMWR Morbidity and mortality weekly report. 2013; 62(13):245.
16-Shabani M, Hadeiy S.K, Parhizgar P,    Zamani N,   Mehrad H,  Hassanian-Moghaddam H, et al. Lead poisoning; a neglected potential diagnosis in abdominal pain. BMC Gastroenterol 2020; 20, 134. DOI: 10.1186/s12876-020-01284-1
17-Neghabi Z, Amiri H, Aghabiklooei A, Saburi Shekofte H. Relationship of serum lead level in patients consuming oral opium with abdominal pain. J Prev Epidemiol. 2019; 4(2):e10.
18-Froutan H, Kashefi Zadeh A, Kalani M, Andrabi Y. Lead toxicity: a probable cause of abdominal pain in drug abusers. Med J Islam Repub Iran 2011; 25 (1):16-20.
19- Amin-Esmaeili M, Rahimi-Movaghar A, Sharifi V, Hajebi A, Radgoodarzi R, Mojtabai R, et al. Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. Addiction. 2016 Oct; 111(10):1836–47. PMID: 27177849 DOI: 10.1111/add.13453
20-Moghimi Sarani E,  Ahmadi J , Oji B Mahi-Birjand M, Bagheri N, etal. Investigating the sequential patterns of methamphetamine use initiation in Iran. Subst Abuse Treat Prev Policy.2020 Jul 29; 15(1):52.Doi: 10.1186/s13011-020-00297-z
21- Hayatbakhsh MM, Oghabian Z, Conlon E, Nakhaee S, Amirabadizadeh AR, Zahedi MJ, et al. Lead poisoning among opium users in Iran: an emerging health hazard. Substance abuse treatment, prevention, and policy. 2017; 12(1):43.
22- Afzali S, Torabian S, Taheri SK. Do Opium Abusers Develop Lead Toxicity? A Study on Opium Abusers in Hamadan, Iran. Asia Pacific Journal of Medical Toxicology. 2017; 6(2):55-8. DOI:10.22038/apjmt.2017.8951
23- Nemati A, Jafari S, Afshari M, Dahmardeh S, Tabrizian K. Comparing Blood Lead Level among Oral/inhaled Opium Addicts with a Non-addict Control Group in the Southeast of Iran. Addiction & health. 2016; 8(4):235.
24- Farzaneh E, Habibzadeh A, Mehrpour O. Lead Toxicity among Oral Opium Addicts with Abdominal Pain: A Case Series of 17 Cases. Indian Journal of Forensic Medicine & Toxicology. 2017; 11(2). DOI: 10.5958/0973-9130.2017.00057.3