Ling R1, Goodman D1
1St Vincent’s Hospital Melbourne, Fitzroy, Australia
Background: Pica syndrome is the chronic intake of a substance without nutritional properties. This can be either simple ‘ice’ pica or ‘hard’ pica, which includes chalk, starch, soap, sand, clay, wood and soil. Pica has been described in children, pregnancy, mental illness, and those who are iron deficient.
Case Report: A 56-year-old Caucasian man, who has been dialysis dependent for 9 years, was diagnosed with Pica syndrome after dialysis staff investigated the cause of scratching noises in the dialysis unit walls. He was found eating mortar directly off the building. Of note, his past medical history is also significant for depression, gastric reflux, opioid dependence and iron deficiency anaemia. He was initially managed with the correction of underlying mineral and nutritional deficiencies with iron and vitamin replacements, with concurrent psychological support.
Conclusions: Pica often remains unrecognised unless it causes a metabolic abnormality. This may be due to lack of information and underreporting about the magnitude and relevance of this issue in end stage renal disease. A cross-sectional study revealed up to 42% of dialysis patients have pica. Contributors to pica in renal failure may include emotional stress and iron deficiency. It has been hypothesised that malnutrition may be both a cause and consequence of pica syndrome. Other consequences may include metabolic disturbances and excessive fluid intake, which are particularly important in dialysis patients. This case highlights the under-recognised occurrence of Pica syndrome in the dialysis population and its important implications on the nutritional status of patients with kidney disease. Pica can also affect the intake and control of electrolytes, which in turn is an important issue in end stage renal disease.
Rebecca Ling is a second year nephrology advanced trainee currently working at St. Vincent’s Hospital Melbourne, Victoria. She is passionate about research that is translatable to clinical practice.