RT Journal Article SR Electronic T1 Lead encephalopathy in an adult opioid abuser JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e240977 DO 10.1136/bcr-2020-240977 VO 14 IS 9 A1 Suleman, Fatima A1 Shoukat, Karima A1 Arshad, Ainan A1 Khan, Nadeem Ullah A1 Sheikh, Usman YR 2021 UL http://casereports.bmj.com/content/14/9/e240977.abstract AB 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.