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Use of whole bowel irrigation in an infant following iron overdose
G W Everson1, E J Bertaccini, J O'Leary
1Regional Poison Center, Santa Clara Valley Medical Center, San Jose, CA 95128.
Insights
Whole bowel irrigation effectively removed iron tablets from an infant's stomach when other methods failed. This safe and efficient treatment is crucial for pediatric iron poisoning cases.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Gastroenterology
Background:
- Iron poisoning is a common pediatric emergency.
- Conventional gastrointestinal decontamination methods like emesis and lavage are often used but can be ineffective.
- Delayed presentation or large ingestions may require alternative strategies.
Observation:
- An 11-month-old infant ingested a significant amount of elemental iron (130-150 mg/kg).
- Initial decontamination with emesis and gastric lavage over 4 hours failed to remove all iron tablets, with radiographs showing at least 16 whole tablets remaining.
- A second lavage 8 hours post-ingestion was also unsuccessful in clearing the tablets.
Findings:
- Whole bowel irrigation (WBI) with polyethylene glycol electrolyte lavage solution was initiated 14 hours after ingestion.
- Serial abdominal radiographs demonstrated successful tablet clearance from the stomach within 4 hours of starting WBI.
- This suggests WBI can be a safe and effective intervention for pediatric iron poisoning when standard methods fail.
Implications:
- Whole bowel irrigation should be considered as a safe and effective treatment option for pediatric iron poisoning when conventional decontamination is insufficient.
- Early consideration of WBI may prevent complications associated with retained iron tablets.
- This case highlights the importance of advanced gastrointestinal decontamination techniques in managing severe pediatric ingestions.
Abstract:
An 11-month-old, 11-kg infant presented to the emergency department after ingesting 130 to 150 mg/kg of elemental iron. Emesis was induced twice and the child was lavaged throughout a 4-hour period with some tablet return. An abdominal radiograph after gastrointestinal decontamination showed at least 16 whole iron tablets remaining in the stomach. Serum iron drawn 2 hours postingestion was 46.7 mumol/L. Blood glucose was 7.7 mmol/L and white blood count was 21,800 mm3. Despite a second lavage 8 hours postingestion, a large number of whole tablets were visualized in the stomach per radiograph. Whole bowel irrigation with polyethylene glycol electrolyte lavage solution (Golytely, Braintree Laboratories, Inc, Braintree, MA) was begun via nasogastric tube 14 hours after the ingestion. Serial abdominal radiographs showed tablet movement out of the stomach within 4 hours after initiating whole bowel irrigation. This case demonstrates the safety and efficacy of WBI in an infant when conventional gastrointestinal decontamination has failed.