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Water reduces iron toxicity.

Bo-Sheng Wu1,2,3, Feng-Yuan Chu1,2, Chih-Yu Yang1,2,3,4,5,6

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Elderly patient ingested hand warmers mistaking them for food. Premixing with water prevented thermal injury and iron toxicity, highlighting ingestion method

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Area of Science:

  • Toxicology
  • Emergency Medicine
  • Radiology

Background:

  • Disposable hand warmers contain iron powder, posing a risk of thermal injury and iron toxicity if ingested.
  • Accidental ingestion requires prompt medical evaluation to assess potential complications.

Observation:

  • An 86-year-old man presented with vomiting and melena after ingesting hand warmers mixed with water.
  • Physical examination revealed no thermal injury or abdominal tenderness.
  • Abdominal X-ray showed radiopaque material; serum iron and deferoxamine challenge test were normal.

Findings:

  • Premixing hand warmer contents with water rapidly halted the iron oxidation reaction, preventing thermal injury.
  • Poor absorption of ferric oxide by the gastrointestinal tract prevented systemic iron intoxication.
  • Abdominal plain films effectively confirmed iron ingestion and monitored its elimination.

Implications:

  • Clinicians should inquire about the method of hand warmer ingestion (premixed with water or dry) to predict injury risk.
  • This case underscores the importance of radiographic confirmation and monitoring of ingested radiopaque materials.
  • Understanding the reaction kinetics and absorption of ingested hand warmer components is crucial for patient management.