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

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 patients 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.