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What is Pagophagia and How is it Treated?

Pica patient, status post gastric bypass, improves with change in medication regimen

Pica

Causes: Iron Deficient Anemia
Although compulsive consumption of ice is frequently associated with a deficiency of iron, the exact etiology of this form of pica is not well-understood. There is one hypothesis that states consumption of ice activates a vasoconstrictive response which causes an increase of blood flow to the brain. Fatigue is the most common symptom experienced in iron-deficiency anemia due to decreased levels of oxygen delivered to the brain, so the increase of blood flow to the brain through consumption of ice may increase alertness and improve the symptoms of fatigue. In support of this hypothesis, individuals with iron-deficient anemia were found to have improved response times on neuropsychological tests than compared to healthy controls when chewing ice.

Several reports have demonstrated the improvement or resolution of pagophagia when given iron supplementation. People with iron-deficiency anemia who showed symptoms of pagophagia had complete resolution of their symptoms when their iron levels were treated, suggesting the association between serum iron levels and symptoms of pagophagia. In another case, an individual who presented with pagophagia was prescribed 325 mg tablets of Ferrous sulfate twice daily. The individual was also administered 1000 mg of low molecular weight dextran over 1 hour and their symptoms of pagophagia were immediately resolved. In another case, a woman with iron-deficiency anemia related to gynecological bleeding was admitted and her dietary screening showed consumption of about 80 ice cubes for day for the past 5 years. She was given iron supplementation and her anemia was treated along with the disappearance of pagophagia within two weeks.

Implications for Practice (Include under diagnosis)
Suggest to clinicians how to perform clinical screening for patients at risk for ice pica

Recommend treatment and follow-up care

Screening for pagophagia may help clinicians gather valuable information towards the diagnosis and treatment, especially populations who are at risk, for iron deficiency. Women who are menstruating, pregnant, or lactating may benefit from pagophagia screening because of the high occurrence of iron deficiency in these groups. Other groups at risk due to prevalence of iron deficiency include blood donors, individuals who are post-surgery or post-trauma, or people who experience malabsorption of iron. When screening for suspected pagophagia, it may be appropriate to include screening for iron deficiency.

Collecting information during health screening to determine any causes of blood loss, malabsorption of iron from the diet, and any laboratory tests to determine iron deficiency may be appropriate in people who present with symptoms of pagophagia. If iron deficiency is confirmed by laboratory screening, iron replacement therapy can be considered with oral supplementation. Over the counter or prescription formulations of iron containing ferrous gluconate, ferrous sulfate, or ferrous fumarate are available.