![]() Ī 31-year-old white woman with a past medical history of menorrhagia, anemia, and recurrent calcium nephrolithiasis presented for preoperative evaluation prior to ureterolithotomy. Increased sodium excretion promotes calcium excretion which facilitates the formation of calcium stones. In a patient with normal renal function, increased sodium intake is excreted by the kidneys to maintain homeostasis. A high sodium diet increases risk for nephrolithiasis. Her pica symptoms and anemia resolved following treatment with a 4-week course of parenteral iron following failure of 1 month of orally administered iron therapy. In 1985, Shapiro and Linus described a 33-year-old woman with hypertension and history of dysfunctional uterine bleeding who experienced very similar salt cravings and was diagnosed with salt pica secondary to iron deficiency anemia. Sodium chloride pica is a very rare form of pica. In some patients, pica symptoms may be short lived, but in other patients the symptoms may persist for longer periods undiagnosed and have more adverse health effects. The long-term consequences of pica are not well understood toxicity from metabolic abnormalities arising from elemental and vitamin deficiencies, as well as bowel obstruction, excessive calorie intake, and dental damage have all been observed in the short term. Pica has been documented in written history since the time of Hippocrates. Pica is most frequently seen in pregnant women, children, and people of low socioeconomic class. It has been estimated that pica occurs in as many as 50% of patients with iron deficiency anemia. ![]() Cravings for non-nutritive food items including sand or clay (geophagia), gravel or stone (lithophagia), ice (pagophagia), and starch (amylophagia) become compulsions that interfere with the patient’s day-to-day life. ![]() Pica is a well-known physical manifestation of nutrient deficiency, most commonly iron. Specific questioning about pica symptoms in patients with iron deficiency anemia and recurrent nephrolithiasis may be helpful diagnostically and therapeutically. Treatment of anemia and resolution of pica may prove effective in preventing future nephrolithiasis. It is important that clinicians consider the possible diagnosis of sodium chloride pica in patients with iron deficiency anemia and recurrent nephrolithiasis. She continues to struggle with the symptoms of pica and orally administered supplementation. She was prescribed orally administered ferrous sulfate 325 mg three times a day with meals. History, physical, and laboratory data were consistent with pica secondary to iron deficiency anemia. Laboratory findings revealed hemoglobin of 10.9 g/dL with ferritin of 3 ng/mL. These cravings had been present for many years, were bothersome to her, and interfered with her daily life. She described a daily pattern of eating continually from a cup of ice chips accompanied by multiple spoons of salt directly out of a salt shaker. Case presentationĪ 31-year-old white woman with a past medical history of menorrhagia, anemia, and recurrent calcium nephrolithiasis presented for preoperative evaluation prior to ureterolithotomy. Treatment of pica may prove effective in preventing recurrent nephrolithiasis. We describe the case of a 31-year-old woman with recurrent calcium nephrolithiasis and anemia who ate ice chips as well as spoons of salt daily. ![]() Pica, or the ingestion of non-food or non-nutritive items, is a well-known manifestation of iron deficiency. Iron deficiency anemia is a common finding in women of child-bearing age. ![]()
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