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Acute iron poisoning: clinical picture, intensive care needs and outcome

Sunit C Singhi1, Arun Kumar Baranwal, Jayashree M

  • 1Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. drsinghi@glide.net.in

Indian Pediatrics
|January 15, 2004
PubMed

Insights

Acute iron poisoning in children is uncommon but serious. Clinical signs and ingested dose are key for management, as serum iron levels and urine color are unreliable indicators of toxicity.

Area of Science:

  • Pediatric Emergency Medicine
  • Toxicology
  • Critical Care

Background:

  • Accidental iron poisoning is a significant concern in pediatric populations.
  • Understanding the clinical profile and outcomes is crucial for effective management.

Purpose of the Study:

  • To determine the prevalence of acute iron poisoning in children presenting to a pediatric emergency department.
  • To analyze the clinical characteristics, treatment strategies, and outcomes of these cases.
  • To identify factors influencing intensive care unit (ICU) needs.

Main Methods:

  • A 5-year retrospective study of patient visits to a pediatric emergency service.
  • Analysis of data from 27,125 patient visits, identifying 337 cases of accidental poisoning, with 21 confirmed as iron poisoning.
  • Review of clinical signs, treatment interventions (including gastric lavage and desferrioxamine), and patient outcomes.

Main Results:

  • Iron poisoning accounted for 7% of accidental poisonings (21 out of 337 cases).
  • Common symptoms included vomiting, diarrhea, malena, and hematemesis within 6 hours of ingestion.
  • Nine patients developed shock or impaired consciousness; two had acute liver failure. Four deaths occurred, predicted by shock, liver failure, coagulopathy, or acidosis.
  • Clinical signs and ingested dose were more reliable than serum iron levels for guiding management. Desferrioxamine infusion and supportive shock care were primary treatments.

Conclusions:

  • Acute iron poisoning, though infrequent, necessitates prompt recognition and management based on clinical presentation and ingested dose.
  • Serum iron levels and desferrioxamine-induced urine color changes are not consistently reliable indicators of toxicity or treatment effectiveness.
  • Aggressive supportive care, particularly for shock, and timely desferrioxamine administration are vital for improving outcomes in pediatric iron poisoning.

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