Lead toxicity as an etiology for abdominal pain in the emergency department

Abstract

Background: Abdominal pain is an uncommon presentation of lead toxicity in the emergency department (ED). However, making the diagnosis is important in avoiding unnecessary testing and the long-term sequelae of lead toxicity.

Objectives: To illustrate possible presentations of abdominal pain secondary to lead toxicity and highlight the importance of taking a thorough patient history.

Case report: We report 2 patients who presented to the ED with abdominal pain and underwent extensive evaluations that did not reveal an etiology. At follow-up visits, their occupational histories revealed possible lead exposures from working for a bullet-recycling company. Tests revealed that each patient had extremely high lead levels and they were both treated for lead toxicity. Their abdominal pain resolved as their lead levels decreased.

Conclusion: These cases demonstrate a rare but significant cause of abdominal pain in the ED. Although history-taking in the ED is necessarily brief, these cases underscore the importance of obtaining an occupational history.

Keywords: abdominal pain; lead; lead toxicity; occupational history.