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Serum iron concentrations and symptoms of acute iron poisoning in children
P A Chyka1, A Y Butler, J E Holley
1Department of Clinical Pharmacy, University of Tennessee, Memphis, USA.
Insights
Serum iron levels do not reliably predict acute toxicity in children with iron poisoning. Further research is needed to establish the value of serum iron concentrations in emergency assessments.
Area of Science:
- Pediatric Toxicology
- Clinical Chemistry
Background:
- Iron poisoning is a common pediatric emergency.
- Assessing toxicity severity is crucial for timely intervention.
Purpose of the Study:
- To investigate the correlation between serum iron concentrations and the development of symptoms in children with acute iron poisoning.
Main Methods:
- Retrospective study of medical records from 1976-1992 at a tertiary care children's medical center.
- Included 92 children with acute iron ingestion and serum iron levels >150 µg/dL before deferoxamine administration.
- Serum iron levels were measured within 2-9 hours of exposure.
Main Results:
- Mean serum iron concentrations varied among patients with different symptom presentations (cardiovascular instability, CNS changes, GI symptoms, no symptoms).
- Significant overlap was observed in serum iron concentration ranges between symptomatic and asymptomatic patients.
- Patients with cardiovascular instability had higher mean serum iron levels, but ranges overlapped considerably with other groups.
Conclusions:
- Serum iron concentrations alone may not accurately reflect acute iron toxicity severity in children.
- Additional studies are required to validate the utility of serum iron levels and explore alternative assessment strategies for acute iron poisoning.
Study Objective:
To determine whether serum iron concentrations correlate with the development of symptoms of iron poisoning in children.
Design:
A retrospective study of medical records from January 1976 through June 1992.
Setting:
A tertiary care children's medical center.
Patients:
Criteria for patient selection included an acute ingestion of iron-containing drugs, measurement of serum iron prior to deferoxamine administration, and a serum iron concentration (obtained within 2-9 hours of exposure) that was greater than 150 micrograms/dl (27 mumol/L). Of the 128 children who were hospitalized for acute iron poisoning, 92 patients (mean age 2.3 +/- 2.2 years) met the selection criteria.
Interventions:
None.
Measurements And Main Results:
The mean (+/-SD) serum iron concentrations (microgram/dl) of patients who exhibited cardiovascular instability (725 +/- 555, n = 6; p < 0.001) differed from those categorized with central nervous system changes (373 +/- 77, n = 30), gastrointestinal symptoms (334 +/- 83, n = 44), and no symptoms (368 +/- 102, n = 12). Serum iron concentrations in patients with cardiovascular instability ranged from 205-500 micrograms/dl (37-269 mumol/L), whereas those with no symptoms ranged from 170-513 micrograms/dl (30 to 92 mumol/L) demonstrating considerable overlap of ranges.
Conclusions:
Serum iron concentrations do not necessarily relate to acute toxicity, and further study is needed to demonstrate the value of serum iron concentrations and to identify alternative strategies in the emergency assessment of the acutely poisoned child.