Complications of pica are generally classified into five groups.4,13 First is inherent toxicity where there are direct toxic effects from the consumption of lead, mercury, arsenic or other heavy metals. An example is eating paint chips from lead paint or soil surrounding a house painted with lead-based paint. In a child, this can cause irreversible neurological damage. In an adult, it can cause behavior changes. Another example is consumption of clay which could lead to hypokalemia. Potassium is a critical electrolyte, necessary for proper nerve and muscle cell function, especially in the heart. Second is the risk of obstruction or aspiration. Bezoars, indigestible masses that lodge in the digestive tract, may form. A trichobezoar forms as a result of hair eating. Consumption of other objects, such as metal, can block the trachea, esophagus or intestines. Subsequent perforation, peritonitis and death can result. Third is excessive caloric intake, typically seen in amylophagia (starch eating). Fourth is general nutritional deprivation. Nonnutritive items like dirt, gravel, wood or ice are eaten in place of a variety of nutritive foods. Young children may exhibit a failure to thrive and adults may appear anorexic. Fifth is other complications such as parasitic infections or dental injury. If contaminated feces or dirt are consumed, toxoplasmosis (infection from a parasite found in cat feces) or toxocariasis (infection from a roundworm found in dog and cat feces) may result. While healthy adults may not develop symptoms, children, immunocompromised individuals and pregnant women are at greater risk for developing a severe infection.13
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