Related Experiment Videos
Diagnosis and management of acute iron poisoning
Insights
Accidental iron tablet ingestion can cause fatal poisoning in children. Early removal of iron from the intestine and chelation therapy are crucial for survival.
Area of Science:
- Toxicology
- Pediatrics
- Emergency Medicine
Background:
- Accidental iron tablet ingestion poses a severe poisoning risk to children.
- Iron poisoning can lead to hypovolemic shock and cellular dysfunction, particularly affecting mitochondria.
Observation:
- Once iron reaches critical levels within mitochondria, therapeutic interventions become less effective.
- Early management is paramount, focusing on intestinal iron removal before systemic absorption.
Findings:
- Parenteral chelation therapy aims to prevent cellular iron entry and protect mitochondria.
- Maintaining effective circulating blood volume is essential for managing iron poisoning.
Implications:
- Iron poisoning is prevalent in regions with routine prenatal iron supplementation without adequate safety measures for children.
- Child-proof packaging is the most effective preventive measure, though not universally practical.
- Prenatal iron prophylaxis should be targeted to areas with high iron deficiency prevalence, coupled with public and professional education.
Abstract:
All children who ingest iron tablets accidentally are at risk of severe, possibly fatal, poisoning. Death in the first stage of acute iron poisoning is due to hypovolaemic shock; in the third stage it is due to widespread cellular dysfunction as a result of mitochondrial disruption caused by intracellular iron. It appears that once a critical amount of iron has reached the mitochondria therapy has little effect and the outcome is poor. Rational therapy must be started without delay. The crucial aspect of early management is to remove as much iron as possible from the intestine before absorption and tissue uptake can occur. The aims of parenteral chelation therapy are to prevent iron in the extracellular fluid from entering the cells and to protect the mitochondria from iron already in the cells. An effective circulating blood volume must be maintained. Iron poisoning occurs predominantly in areas where iron is given routinely to mothers during pregnancy without sufficient regard for its potentially lethal effects on toddlers. Child-proof packaging is the single most effective way to prevent iron poisoning but it is expensive and not practical in poor countries. Iron prophylaxis in pregnancy should be routine only in areas where a high prevalence of iron deficiency justifies it. It should be accompanied by education of the public, pharmacists, nurses and doctors.