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Lead encephalopathy in an adult opioid abuser
  1. Fatima Suleman1,
  2. Karima Shoukat2,
  3. Ainan Arshad3,
  4. Nadeem Ullah Khan1 and
  5. Usman Sheikh4
  1. 1Aga Khan University Hospital, Karachi, Pakistan
  2. 2Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
  3. 3Medicine, Aga Khan University, Karachi, Pakistan
  4. 4Department of Haematology, Aga Khan University Hospital, Karachi, Pakistan
  1. Correspondence to Dr Ainan Arshad; ainan_arshad{at}


A 38-year-old man presented at the emergency department with abdominal pain, vomiting, generalised weakness and altered consciousness. He had been ingesting opioids for over 5 years and had several past hospital admissions for abdominal pain. His investigations showed deranged liver function tests, anaemia and basophilic stippling on the peripheral blood smear. Further investigations revealed a significant increase in the serum lead level. We started chelation with peroral penicillamine 250 mg every 6 hours for 2 days and switched to intramuscular dimercaprol 4 mg/kg every 12 hours and intravenous calcium ethylenediamine tetraacetic acid 50 mg/kg in two divided doses daily for the next 5 days. We then discharged him home; he had become clinically stable by that time. We repeated his lead level and followed him up in the clinic. In this report, we emphasise the consideration of lead toxicity in opioid abusers and bring to attention a rare way of lead chelation in resource-limited settings.

  • exposures
  • adult intensive care
  • toxicology

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  • Contributors AA was the primary internal medicine consultant managing the patient while he was admitted in the hospital and also followed him in clinic once he was discharged. Patient was admitted under his care. He has provided a critical review on manuscript draft, took consent from the patient for reporting the case, asked for the patient’s perspective, and acts as the guarantor of the study. KSS was the internal medicine team resident, managing the patient while he was admitted in the hospital. She provided intellectual input while preparing the manuscript draft and also reviewed it. FFS was the internal medicine team intern, managing the patient while he was admitted in the hospital. She analysed the data and prepared the manuscript draft. NUK reviewed the patient from toxicology point of view, suggesting the required treatment in lead poisoning. He also provided a critical review on manuscript draft. US reviewed the patient’s haematology and provided his opinion on the patient’s peripheral smear. He also provided the picture of peripheral smear slide for submission in the case report manuscript. All authors had full access to the study data, and all of them approved the final manuscript before it was submitted to BMJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.