Pica
Pica: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
Pica refers to the craving and ingestion of normally inedible substances, such as plaster, charcoal, clay, wool, ashes, paint, or dirt. In children, the most commonly affected group, pica typically results from nutritional deficiencies. It’s commonly seen in pregnant patients and may be associated with iron deficiency anemia due to increased demands for iron. However, in adults, pica may reflect a psychological disturbance. Depending on the substance eaten, pica can lead to poisoning and GI disorders.
History and physical examination
Begin by determining what substances the patient has been eating. If the patient has eaten toxic substances, such as lead, obtain a serum lead level. If the patient is a child, ask the parents to describe his eating habits and nutritional history. When did the child first display pica? Does he always crave the same substance? Is he listless or irritable?
Check the patient’s vital signs, noting especially bradycardia, tachycardia, or hypotension. Then inspect the abdomen for visible peristaltic waves or other abnormalities. Observe the hair, skin, and mucous membranes for changes, such as dryness or pallor.
Medical causes
Anemia (iron deficiency)
Chronic, severe iron deficiency anemia may cause pica for dirt, paint, cornstarch, nails, or clay (although controversy exists over whether pica is the cause or the result of the deficiency). Pica may also cause fatigue, irritability, listlessness,and anorexia. The patient may complain of light-headedness, headache, an inability to concentrate,dysphagia,and exertional dyspnea. His muscle tone is poor, and he may experience paresthesia in his extremities. His nails are brittle and spoon shaped, his tongue is smooth, and his skin and mucous membranes are pale.
Malnutrition
Severe malnutrition and starvation may cause pica for any substance, including dirt. Besides marked weight loss, the patient may develop muscle wasting and paresthesia in the extremities. He appears lethargic and apathetic. His skin is dry, thin, and flaky. His sparse, dull hair falls out easily. His nails are brittle, his cheeks are dark and swollen, and his lips are red and swollen. The patient may also experience nausea and vomiting, hepatomegaly, bradycardia, hypotension, slow and shallow respirations, and amenorrhea or gonadal atrophy.
Psychological disorders
Pica can occur with psychological disorders marked by profound impairment, such as schizophrenia and autism.
Cultural cue Pica is an accepted practice in some cultures, based on presumed nutritional or therapeutic properties or on religious or superstitious beliefs.
Pediatric pointers
Many older homes contain lead-based paints. Children who live in older homes may be at risk for lead poisoning from eating chipped paint or even from sucking their fingers if the lead paint has infiltrated house dust. Serum lead levels of inner-city children and children in older homes should be monitored. Refer them to a dietitian for nutritional counseling.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Medical Books Excerpts
- Pica
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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