Abdominal pain related to adulterated opium: An emerging issue in drug addicts

Table 1 Reports of lead poisonings due to adulterated-opium abuse and their supplementary data

Type of study	Country	Gender–age/mean age (y/o)	Route of abuse	Major clinical findings	Laboratory findings	BLL (µg/dL)	Treatment	Ref.
Case report	Iran	M-34	Ingestion	AP, N/V	Anemia, basophilic stippling of erythrocytes, elevated liver enzymes	95	CaNa2EDTA	[9]
Case report	Iran	M-57	Ingestion	AP, nausea, severe constipation	Anemia, elevated liver enzymes	81	CaNa2EDTA	[9]
Case report	Iran	M-45	Ingestion	Epigastric and periumbilical AP	Anemia, elevated liver enzymes	37.5	Opium cessation	[9]
Case report	Iran	M-65	Ingestion	AP, Burton's line, generalized ileus, N/V	Anemia, elevated liver enzymes	150	Dimercaprol + CaNa2EDTA	[11]
Case report	Iran	M-25	Ingestion and inhalation	AP, malaise, N/V, weakness, excess sweating, dark urine, generalized bone pain	Anemia, elevated liver enzymes	350	Dimercaprol + CaNa2EDTA	[16]
Case report	Netherlands	M-40	Ingestion	AP	Anemia, basophilic stippling, elevated liver enzymes	86	Dimercaprol + CaNa2EDTA	[17]
Case report	Iran	M-40	Ingestion	Paresthesia in upper and lower extremities, low muscle strength, abdominal tenderness, late onset quadriplegia	Anemia, elevated liver enzymes	> 200	Dimercaprol + CaNa2EDTA, followed by Succimer	[18]
Case report	Iran	M-32	Ingestion	AP, constipation, loss of appetite	Basophilic stippling	50	Dimercaprol	[19]
Descriptive, cross-sectional	Iran	M/F-average age: 41.8 ± 13.5	Ingestion	AP, anorexia, weight loss, constipation, nausea	Anemia	Average: 145 ± 61	NA (referred to toxicologists)	[20]
Descriptive, retrospective	Iran	M-20 to 39	Inhalation	Abdominal cramps	Anemia	Average: 109 ± 37.6	Dimercaprol ± CaNa2EDTA	[21]
Case report	Iran	M-38	Ingestion and inhalation	Severe AP, Burton’s line, muscle weakness, myalgias, and bad temper	Basophilic stippling	73	Dimercaprol + CaNa2EDTA, DP	[22]
Case report	Singapore	F-40	Ingestion and inhalation	Severe lower AP	Anemia, punctate basophilia	NA	Calcium gluconate, calcium disodium versenate	[7]
Case report	Singapore	M-63	Ingestion	AP	Anemia, punctate basophilia	NA	Calcium gluconate, calcium disodium versenate	[7]
Case report	United Kingdom	M-46	Inhalation	Colicky AP, constipation, irritability and malaise	Extravascular haemolytic anaemia with punctate basophilic stippling	113.8	CaNa2EDTA	[23]
Case report	Iran	M-32	Ingestion	Dysarthria and progressive upper limb weakness following a refractory AP, constipation, nausea and headache	Anemia, high liver function tests and bilirubin	256	DP	[24]
Case report	Iran	F-36	Ingestion	Sever colicky AP, NV, Pleuritic chest pain, ejection fraction 30%, massive bilateral pleural effusion	Anemia (hypochromic- microcytic)	78	CaNa2EDTA	[25]
Case series	Iran	M/F-average age: 50.4 ± 13.4	Ingestion	Acute sever AP	Anemia	Average: 76.2	NA	[26]
Case series	Netherlands	M-average age: 44	Ingestion	AP, NV	Anemia, elevated liver enzymes	Average: 179.4	CaNa2EDTA	[27]
Case series	Iran	M-average age: 49.82 ± 11.52	Ingestion	AP, Loss of Appetite, Sleep Disturbance, Fatigue, Constipation	Anemia	Average: 93.36 ± 27.84	DP	[28]

M: Male; F: Female; N/V: Nausea and/or vomiting; AP: Abdominal pain; BLL: Blood lead level; NA: Not available; DP: D-penicillamine.