pagophagia

Pagophagia is a form of pica in which a person persistently chews ice or consumes large amounts of ice or ice-cold beverages. It is typically described as a nonnutritive craving, not a normal habit, and can occur in various settings, most frequently in association with iron deficiency anemia.

The exact mechanism linking pagophagia to iron deficiency is not fully understood. Theories include alterations in taste or appetite due to iron deficiency, relief of oral mucosal irritation from cold temperatures, or a behavioral response that develops in the context of developmental or psychiatric conditions. While iron deficiency is the strongest commonly documented association, pagophagia can occur without anemia in some cases.

Clinical features include a clear urge to chew ice, repeated ice chewing or chewing of ice-containing beverages, and potential dental consequences such as enamel wear, dental fractures, or mucosal injuries. Rarely, excessive ice consumption can contribute to esophageal irritation or other complications.

Diagnosis is primarily clinical, based on history and confirmed by laboratory testing showing iron deficiency or iron-deficiency anemia (low ferritin, low serum iron, low transferrin saturation, and microcytosis). It is important to evaluate for other causes of pica and to assess nutritional status, pregnancy status, and underlying medical or psychiatric conditions.

Management focuses on treating iron deficiency with appropriate iron supplementation and addressing underlying causes. Dietary counseling, dental evaluation, and behavioral strategies may aid reduction or cessation of ice chewing. In some cases, pagophagia resolves with correction of iron status; multidisciplinary care may be needed for persistent or recurrent symptoms.