Pagophagia is the compulsive consumption of ice or iced drinks.

It is a form of the disorder known as pica.

Refers to the persistent consumption of nonnutritive substances for over a period of at least one month.

Pagophagia has been shown to be associated with iron-deficiency anemia and responsive to iron supplementation.

Risk factors:

Iron-deficiency anemia, psychological distress, pregnancy.

Treatment : 

Iron supplementation

It is hypothesized that chewing on ice causes vascular changes that allow for increased perfusion of the brain, as well as activation of the sympathetic nervous system, which also increases blood flow to the brain, allowing for increased processing speed and alertness.

Fatigue is the most common symptom experienced in iron-deficiency anemia due to decreased levels of oxygen delivered to the brain, the increase of blood flow to the brain through consumption of ice is thought to increase alertness and improve the symptoms of fatigue. 

Patients with iron-deficient anemia are found to have improved response times on neuropsychological tests compared to healthy controls when chewing ice.

Chewing ice may lessen pain in glossitis and stomatitis related to iron-deficiency anemia, but this hypothesis remains controversial.

Chewing ice as it can lead to dental injury.

The main symptom for pagophagia is intense cravings for chewing ice.

A common underlying cause of pagophagia is iron-deficiency anemia, and many people also experience weakness, fatigue, pallor, sore tongue, dizziness, headache, and cold extremities.

Other findings  associated with iron deficiency may include brittle nails, cracking at the corner of the mouth, and restless legs syndrome.

Severe cases of iron deficiency may require increasing cardiac output for decreased oxygen-carrying capacity of the blood.

Improvement or resolution of pagophagia occurs when given iron supplementation, suggesting the association between serum iron levels and symptoms of pagophagia. 

Pagophagia has been reported with calcium deficiency but its pathophysiology is unknown.

Pagophagia has been associated with psychological conditions: compulsive behavior or depressive disorders where pagophagia was used as a coping mechanism to deal with psychological stress.

Other proposed causes of pagophagia include hunger and gastrointestinal distress related to ways the body attempts to ease stress.

Known risk factors for pica include: stress, cultural factors, learned behavior, low socioeconomic status, underlying mental health disorder, nutritional deficiency, child neglect, pregnancy, epilepsy, and familial psychopathology.


Pagophagia is often undiagnosed as those with the condition may consider it to be harmless and not seek medical help unless the behavior begins to interfere with their lives. 

If it remains undiagnosed it may lead to complications: anemia complications may progress to heart failure, tooth sensitivity and dental injury leading to cracked or chipped teeth. 

Overconsumption of ice may cause bloating, gas, and stomach pain. Imaging exams such as abdominal x-rays and endoscopy may be ordered if a person presents with abdominal symptoms.

Diagnosis begins with obtaining a medical history, a physical exam, as a complete blood count and additional tests to determine levels of hemoglobin, hematocrit, serum iron, ferritin, and microscopic evaluation of RBCs.

In the setting of pagophagia. Schizophrenia and psychosis, other eating disorders, substance use, and autism should be considered in the differential diagnosis.

When screening for suspected pagophagia, it is appropriate to include screening for iron deficiency and its etiologic possibilities to determine causes of blood loss.

In one study of pica in iron deficient versus iron replete blood donors, pica was reported in 11% of donors with iron depletion/deficiency, compared with 4% of iron-replete donors.

In a study of men with iron-deficiency anemia pagophagia occurred in 34%.

Men who were older and had higher platelet counts were less likely to have pagophagia compared to younger men and those with lower platelet counts.

Pica is most often seen during pregnancy: estimated 27.8% of pregnant women experience pica, but pica prevalence and manifestation is culturally and geographically heterogenous.

There is a positive correlation between pica in pregnancy with pregnancy complications, lower educational attainment, and use of iron supplementation.

A meta-analysis of the prevalence of pica in German children found that 12.3% of German children have engaged with a pica behavior at some point in their lives.

Pica also a common eating disorder among those who are intellectually impaired.

In children, pica is usually short term, disappearing spontaneously

In a study of American children receiving chronic hemodialysis therapy found that 34.5% of the children studied engaged in pagophagy compared to 12.6% of children who engaged in other forms of pica.

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