{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:02:16Z","timestamp":1756425736462,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,29]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>A 38-year-old man presented at the emergency department with abdominal pain, vomiting, generalised weakness and altered consciousness. He had been ingesting opioids for over 5\u2009years and had several past hospital admissions for abdominal pain. His investigations showed deranged liver function tests, anaemia and basophilic stippling on the peripheral blood smear. Further investigations revealed a significant increase in the serum lead level. We started chelation with peroral penicillamine 250\u2009mg every 6\u2009hours for 2\u2009days and switched to intramuscular dimercaprol 4\u2009mg\/kg every 12 hours and intravenous calcium ethylenediamine tetraacetic acid 50\u2009mg\/kg in two divided doses daily for the next 5\u2009days. We then discharged him home; he had become clinically stable by that time. We repeated his lead level and followed him up in the clinic. In this report, we emphasise the consideration of lead toxicity in opioid abusers and bring to attention a rare way of lead chelation in resource-limited settings.<\/jats:p>","DOI":"10.1136\/bcr-2020-240977","type":"journal-article","created":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T12:01:08Z","timestamp":1632139268000},"page":"e240977","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Lead encephalopathy in an adult opioid abuser"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7035-1047","authenticated-orcid":false,"given":"Fatima","family":"Suleman","sequence":"first","affiliation":[{"name":"Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karima","family":"Shoukat","sequence":"additional","affiliation":[{"name":"Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9013-3899","authenticated-orcid":false,"given":"Ainan","family":"Arshad","sequence":"additional","affiliation":[{"name":"Medicine, Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadeem Ullah","family":"Khan","sequence":"additional","affiliation":[{"name":"Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usman","family":"Sheikh","sequence":"additional","affiliation":[{"name":"Department of Haematology, Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,20]]},"reference":[{"key":"2025082722542267000_14.9.e240977.1","unstructured":"Substance priority list: ATSDR\u2019s substance priority list. 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Lead toxicity. StatPearls publishing, 2019. Available: https:\/\/scholar.google.com\/scholar?as_ylo=2016&q=acute+lead+encephalopathy+in+adults&hl=en&as_sdt=0,5#d=gs_qabs&u=%23p%3D2zTEgR6211AJ [Accessed 3 Jul 2020]."},{"key":"2025082722542267000_14.9.e240977.13","doi-asserted-by":"publisher","DOI":"10.1016\/0006-2952(91)90617-E"},{"key":"2025082722542267000_14.9.e240977.14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12883-020-01750-z","article-title":"Encephalopathy following ingestion of lead-contaminated opium; magnetic resonance imaging findings","volume":"20","author":"Haghighi-Morad","year":"2020","journal-title":"BMC Neurol"},{"key":"2025082722542267000_14.9.e240977.15","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/46.1.41"},{"key":"2025082722542267000_14.9.e240977.16","unstructured":"Mejias SG , Ramphul K . Penicillamine. 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