Related Experiment Videos
Management of acute iron poisoning
Insights
Acute iron poisoning, most common in young children, can be fatal but deaths are rare. Early treatment and reporting of minor exposures may explain fewer severe cases over time.
Area of Science:
- Toxicology
- Pediatrics
- Emergency Medicine
Background:
- Acute iron poisoning is a significant concern, particularly in children under 5.
- Iron salts are directly toxic to the gastrointestinal tract and can cause systemic metabolic disturbances.
Observation:
- The clinical course presents in four distinct phases, with gastrointestinal irritation being prominent in the initial hours.
- Severe poisoning is characterized by neurological impairment, metabolic acidosis, and shock.
- A later phase can involve stenosis due to mucosal ulcer healing, primarily in young children.
Findings:
- While potentially fatal, fatalities from acute iron poisoning are infrequent.
- The proportion of severe cases appears to be decreasing, possibly due to improved management and reporting.
- Assessing poisoning severity is challenging due to unpredictable iron absorption and unreliable clinical features.
Implications:
- Further research into acute iron poisoning is needed due to infrequent cases and unsatisfactory evidence for management.
- Accurate severity assessment is crucial for effective treatment but remains difficult.
- Understanding the phases of iron poisoning aids in timely diagnosis and intervention.
Abstract:
Acute iron poisoning is most common in children below the age of 5 years. While there is no doubt that it may be fatal, recent surveys show that death occurs in only a very small percentage of cases and that iron salts are responsible for a small minority of fatalities due to overdosage with drugs. Similarly, the proportion of severe cases seems to have fallen over the last thirty years, possibly due to earlier and more aggressive treatment but more probably due to an increase in the number of minor exposures reported. Iron salts are directly toxic to the gastrointestinal tract causing vomiting, diarrhoea, abdominal pain and occasionally significant blood loss. They also cause metabolic acidosis by interfering with intermediary metabolism and producing shock and reduced tissue perfusion. The clinical course of acute iron poisoning is divided into 4 phases. Features of acute gastrointestinal irritation dominate the period up to 6 hours after ingestion and most patients do not develop other features or progress beyond this stage. Rarely, blood loss may be sufficient to cause hypotension. Severe poisoning is characterised by impairment of consciousness, convulsions and metabolic acidosis. The second phase, 6 to 12 hours after ingestion, is one of remission of features. Phase 3 comprises the period 12 to 48 hours from ingestion and is reached only by a small minority of patients. Recurrence or development of shock, and metabolic acidosis are usual and renal failure and features of extensive hepatocellular necrosis may develop. The last (fourth) phase, 2 to 6 weeks after ingestion, is only likely to develop in young children and is characterised by recurrence of vomiting due to gastric or duodenal stenosis caused by healing of iron-induced mucosal ulcers. Acute iron poisoning in humans has not been adequately studied and is unlikely to be so now because of the infrequent and sporadic occurrence of cases. The evidence for many conventional aspects of management is therefore unsatisfactory. Assessment of severity of poisoning is an essential prerequisite to optimum management but is difficult. The amount of elemental iron ingested is unacceptable since it is seldom known with accuracy and absorption is unpredictable because of vomiting and diarrhoea. The commonly encountered clinical features are also unreliable although it is generally accepted that coma, shock and metabolic acidosis indicate severe poisoning.(ABSTRACT TRUNCATED AT 400 WORDS)