著者

大原 俊夫 柴田 冨士子

出版者

一般社団法人 国立医療学会

雑誌

医療 (ISSN:00211699)

巻号頁・発行日

vol.23, no.10, pp.1248-1255, 1969-10-20 (Released:2011-10-19)

参考文献数

23

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During the 8 year period from 1960 to 1968, 62 children with pica, 35 males and 27 females, were experienced. The age distribution consisted of 23 between ages of 7 months and 12 months, 18 between 13 and 18 months, 9 between 19 and 24 months, and 12 between 2 years and 14 years.Hypochromic anemia was seen in all cases. The degree was mild in many, with the average hemoglobin of 11.7g/dl and 11 cases had hemoglobin above 13.5g/ dl. Serum iron was determined in 12 cases, the average value being 74γ/dl. No ova of ascaris or anchylostoma were noted.The duration of pica was less than 30 days in 21, between 1 and 6 months in 26, between 7 and 12 months in 11, between 1 and 2 years in 2, and between 3 and 4 years in 2. The nature of objects ingested was dirt (mud, sand, pebbles, wall material, and coal) in 33 cases, paper (newspaper, toilet paper and others) in 13, dust (house-dust, cigarett ash, and ash) in 11, matches (live and spent) in 6, raw rice in 6, and others (celluloid, shoe skin, sole of slippers etc.) in 18. A single person may ingest more than two kinds of objects.Iron preparation was administered in 59 of 62. In most cases preparations for intramuscular injection such as Imferon (iron dextran complex) and Jectofer (iron sorbitol citricc acid complex) were used, while iron preparation for oral administration was used in some cases. For the calculation of the dose of iron in intramuscular calculation, thee following formula was used.Fe(mg)=[0.4(100-Hb%)+17]×W(kg)W=kg weight of patientHb%=observed hemoglobin percentageA complete cure was obtained in 55 of 59 cases, mostly during the period of injection, and very seldom within 3 weeks of the end of the injection period. Relapse was seen in 2 cases, both of which were cured completely after 1 or 2 infections.Although Gutelius et al. 1) found no difference between the group treated with iron and the group treated with saline, the dose of iron they used was only one-half of the amount we and Langkowsky2) used due to the difference in the calculating formula, suggesting the cause of insufficient treatment.They also conducted the final evaluation 13 to 27 months after the injection of iron.This would present another problem. Even if the iron deficiency anemia was treated with sufficient iron preparation, iron deficiency in the food of daily intake would reasonably cause iron deficiency again after 1 or 2 years. Due to the long period of observation environmental factors tend to participate to make the evaluation of the effect of iron. treatment uncertain.According to the results of our treatment, pica is known to occur mostly due to iron deficiency. However, the occurrence in lead poisoning or zinc deficiency3) is also known. In order to explain all these phenomena, we have the following hypothesis. Factors causing hypochromic anemia such as iron deficiency and toxic substance simultaneously become the causative factor of pica. Since most of the hypochromic anemia is caused by iron deficiency, the cause of pica is mostly iron deficiency.Based on such hypothesis, the frequent occurrence of pica in children, females and especially pregnants, the occurrence in parasitic infestation (anchylostomiasis and visceral larva migrans4), lead poisoning, zinc deficiency, and frequent occurrence in developing countries and poor people may all be explained.