Arsenic Toxicity From the Ingestion of Terracotta Pottery



      Symptomatic arsenic toxicity has not been associated with terracotta pottery despite thousands of years of use in food storage and preparation. We describe a case of chronic arsenic toxicity from undiagnosed pica involving the ingestion of terracotta pots.

      Case Report

      A 49-year-old woman with a history of anemia and abnormal uterine bleeding presented to the Emergency Department complaining of lower extremity pain. She was also noted to have chronic lower extremity paresthesia, constipation, and fatigue. She admitted to ingesting glazed and unglazed terracotta pots for the past 5 years. This unusual craving was thought to be a manifestation of pica in the setting of chronic anemia. The patient was found to have an elevated urinary arsenic concentration of 116 µg/24 h. An abdominal radiograph showed opacifications throughout her bowel, and she received whole bowel irrigation.

      Why Should an Emergency Physician Be Aware of This?

      Pica is a common behavior in certain populations. Practicing clinicians should be familiar with the complications of pica, including chronic arsenic toxicity and its associated array of nonspecific symptoms.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yoshida T
        • Yamauchi H
        • Fan Sun G
        Chronic health effects in people exposed to arsenic via the drinking water: dose-response relationships in review.
        Toxicol Appl Pharmacol. 2004; 198: 243-252
        • Rose EA
        • Porcerelli JH
        • Neale AV.
        Pica: common but commonly missed.
        J Am Board Fam Pract. 2000; 13: 353-358
        • Çiftçi TD
        • Henden E.
        Leaching of arsenic from glazed and nonglazed potteries into foods.
        Sci Total Environ. 2016; 569–70: 1530-1535
        • Fawcett EJ
        • Fawcett JM
        • Mazmanian D.
        A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period.
        Int J Gynaecol Obstet. 2016; 133: 277-283
        • Demaegdt H
        • Waegeneers N
        • Cheyns K
        • Ruttens A.
        Does arsenic pose a health concern after consumption of clay products?.
        Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2021; 38: 113-124
        • Henden E
        • Cataloglu R
        • Aksuner N.
        Determination of arsenic leaching from glazed and non-glazed Turkish traditional earthenware.
        Sci Total Environ. 2011; 409: 2993-2996
        • Nelson L
        • Howland MA
        • Lewin NA
        • Smith SW
        • Goldfrank LR
        • Hoffman RS
        Goldfrank's toxicologic emergencies.
        11th ed. McGraw-Hill Education, New York2019
        • Ahmad SA
        • Khan MH
        • Haque M.
        Arsenic contamination in groundwater in Bangladesh: implications and challenges for healthcare policy.
        Risk Manag Healthc Policy. 2018; 11: 251-261
        • Yunus FM
        • Khan S
        • Chowdhury P
        • Milton AH
        • Hussain S
        • Rahman M.
        A review of groundwater arsenic contamination in Bangladesh: the Millennium Development goal era and beyond.
        Int J Environ Res Public Health. 2016; 13: 215
        • Chakraborti D
        • Rahman MM
        • Mukherjee A
        • et al.
        Groundwater arsenic contamination in Bangladesh–21 Years of research.
        J Trace Elem Med Biol. 2015; 31: 237-248
        • Guha Mazumder DN
        • Ghoshal UC
        • Saha J
        • et al.
        Randomized placebo-controlled trial of 2,3-dimercaptosuccinic acid in therapy of chronic arsenicosis due to drinking arsenic-contaminated subsoil water.
        J Toxicol Clin Toxicol. 1998; 36 (Erratum in: J Toxicol Clin Toxicol 1999;37:525): 683-690