Unusual Symptom: Craving and Eating Large Amounts of Ice and Ice Water
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Unusual Symptom: Craving and Eating Large Amounts of Ice and Ice Water

Craving and Eating Large Amounts of Ice and Ice Water are not very rare but often considered a common thing. But too much craving for ice cold water and ice is just a sign of Diabetes insipudus, Gastrointestinal blood loss, Menstrual blood loss, and Chronic hematuria. Etiologies of such symptom is diabetes insipidus which has to categories; central diabetes insipidus and nephrogenic diabetes insipidus.

Craving and Eating Large Amounts of Ice

The symptom of craving and ingesting large amounts of ice, a form of pica known as pagophagia, is a common manifestation of iron deficiency anemia.

The following are the possible etiologies of such symptom:

 Iron Deficiency anemia

Gastrointestinal blood loss

Menstrual blood loss

Chronic hematuria

 Pica, the abnormal craving for unusual type of food or nonnutritive substances, is an occasional manifestation of iron deficiency anemia. Patients may ingest large amounts of salty or crunchy foods such as pretzels, carrots, celery or lettuce. Some patients may ingest tomatoes, dirt, clay or other inert substances such as starch. Children with iron deficiency anemia have been reported to ingest dirt, also known as geophagia, which may result in lead poisoning if lead paint chips are present in the soil.  Pica occurs in approximately 50% of patients with iron deficiency anemia. Pagopagia is a form of pica characteristics by the abnormal craving and ingestion of ice and is by far the most common type of pica in patients with iron deficiency anemia. Pagophagia usually results from iron deficiency resulting from chronic gastrointestinal blood loss. Many patient will not volunteer the information that they ingest large amounts of ice. As such, the clinician should inquire about this symptom if other symptoms and signs of iron deficiency are present. Determination of serum hemoglobin and iron studies should be performed in patients with pagophagia and other types of pica. Treatment of iron deficiency anemia with iron preparations should result in normalization of the hematocrit and resolution of pica.

Craving Ice Water

Intense thirst with the craving for ice-cold water is an occasional symptom of diabetes insipidus

The following are the possible etiologies of such symptom:

Diabetes insipidus

                Central

                Nephrogenic

Diabetes insipidus results from lack of vasopressin (central diabetes insipidus) or renal tubular resistance to vasopressin (nephrogenic diabetes insipidus). Deficiency of vasopressin or renal resistance to vasopressin leads to enhanced renal water loss, which can lead to cardiovascular collapse and hypernatremia if the patient cannot replenish water losses. Central diabetes insipidus may be idiopathic or result from, structural damage to the hypothalamus from metastatic tumors, infection, granulomatous diseases, head trauma, and neurosurgical procedures. Nephrogenic diabetes insipidus may be inherited as an X-linked trait or, more commonly, result from various drugs (e.g. lithium), prolonged urinary tract obstruction, myeloma, sickle cell anemia, and electrolyte abnormalities.  The characteristic clinical picture of diabetes insipidus consists of significant passage of hypotonic urine (up to 20 liters per day) and polydypsia. Patient with diabetes insipidus also commonly complain of intense thirst and may crave ice-cold water, which may be a helpful clue to the diagnosis.  Patients suspected of having diabetes insipidus should have their serum electrolyte measured and, if possible, undergo a water-deprivation test if the diagnosis is in question.  Treatment of central diabetes insipidus consists of synthetic vasopressin administration (DDAVP, desargine des-amino vasopressin). Treatment of nephrogenic diabetes insipidus may be more difficult, although thiazide diuretics may benefit some patients.

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