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Acute Iron Intoxication


Presentation

  • The present report discusses the clinical indications that can support the administration of deferoxamine for iron intoxication in pregnancy and discusses the benefits and risks of its usage.[ncbi.nlm.nih.gov]
  • A case report of acute iron intoxication, management strategies, and a review of the literature are presented.[jhu.pure.elsevier.com]
Fever
  • Concentration 60 - 90 micromol/L and tablets visible on AXR or symptomatic (nausea, vomiting, diarrhoea, abdominal pain, haematemesis, fever).[rch.org.au]
  • Symptoms of the third stage of iron toxicity include low blood pressure, fever and seizures. Liver failure may occur, causing low blood sugar, excessive or prolonged bleeding and jaundice -- yellowish eyes and skin.[livestrong.com]
  • In addition, excessive iron damages mitochondria and causes lipid peroxidation, manifest mainly as renal and hepatic damage.Early signs of iron poisoning include vomiting and diarrhea, fever, hyperglycemia, and leukocytosis.[usmleforum.com]
  • […] hematemesis, explosive diarrhea, irritability, abdominal pain, lethargy If toxicity is severe, tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within 6–48 h Up to 24 h of apparent improvement (latent period) 3 12–48 h Shock, seizures, fever[merckmanuals.com]
  • In other patients the parenteral administration of iron can cause vomiting, chills, fever, headache, joint pain, and urticaria. Food Sources of Iron .[medical-dictionary.thefreedictionary.com]
Pallor
  • Clinical signs are pallor, dyspnea, edema of the head and a secondary diarrhea. organic iron poisoning see iron poisoning (below). iron overload storage of excessive iron in body tissues such as occurs in human idiopathic hemochromatosis is not recorded[medical-dictionary.thefreedictionary.com]
  • The result is fatigue, weakness, headaches, apathy, pallor and poor resistance to cold temperatures. Since hemoglobin is the bright red pigment of the blood, the skin of a fair person who is anemic may become noticeably pale.[drhoffman.com]
Tachypnea
  • Stages of Iron Poisoning Stage Time Postingestion Description 1 Within 6 h Vomiting, hematemesis, explosive diarrhea, irritability, abdominal pain, lethargy If toxicity is severe, tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within[merckmanuals.com]
  • […] such as vomiting, diarrhea, and/or altered mental status; presence of systemic symptoms, including subtle symptoms that can be seen in the latent phase of iron intoxication, such as tachycardia, hypotension, poor peripheral tissue perfusion, and/or tachypnea[mjhid.org]
  • […] hypothermia, ileus Short-acting naloxone (Narcan; brand no longer available in the United States), monitor closely for withdrawal symptoms and relapsing sedation Salicylate Aspirin products Tinnitus, nausea, vomiting, fever, disorientation, lethargy, tachypnea[aafp.org]
  • […] cerebral edema, meningismus (nuchal rigidity, photophobia, headache without infection or inflammation) hypocalcemia occurs due to binding of calcium by oxalic acid and can cause prolonged QT, arrhythmias, myocardial depression second stage: 12 - 24 hours tachypnea[medbullets.com]
  • Pulmonary toxicity (ARDS and tachypnea) has been described following prolonged deferoxamine treatment.35 Ocular and renal toxicities have been described only in patients with thalassemia or renal failure.[healio.com]
Vomiting
  • A 24 y/o male, after attempting suicide by ingesting liquid ferric chloride, presented with protracted vomiting and epigastric pain. He was noted to have leukocytosis, a metabolic acidosis and an elevated serum iron level.[ncbi.nlm.nih.gov]
  • […] discomfort and vomiting but systemic toxicity is not expected.[kidshealthwa.com]
  • Gastric lavage is usually not helpful because vomiting tends to empty the stomach more efficiently. Activated charcoal does not adsorb iron and should be used only if other toxins also were ingested.[merckmanuals.com]
  • Excess of iron may irritate the stomach mucosa giving rise to pain in abdomen, vomiting, nausea, and diarrhea. In case if iron irritates intestinal lining, it can lead to bleeding in stool, and blood vomits.[tandurust.com]
Diarrhea
  • Although moderate amounts of iron may be irritating and may produce diarrhea, larger amounts may cause paralytic ileus. Localized concentrations of iron may then exert corrosive effects and cause segmental infarctions and perforations.[ncbi.nlm.nih.gov]
  • Ferrous chloride, a corrosive substance, causes vomiting, diarrhea, and hemorrhage when taken internally.[medical-dictionary.thefreedictionary.com]
  • In addition, excessive iron damages mitochondria and causes lipid peroxidation, manifest mainly as renal and hepatic damage.Early signs of iron poisoning include vomiting and diarrhea, fever, hyperglycemia, and leukocytosis.[usmleforum.com]
  • Excess of iron may irritate the stomach mucosa giving rise to pain in abdomen, vomiting, nausea, and diarrhea. In case if iron irritates intestinal lining, it can lead to bleeding in stool, and blood vomits.[tandurust.com]
  • GI toxicity includes vomiting, diarrhea, crampy abdominal pain, hematemesis, and melena due to direct mucosal corrosion.[clinicaladvisor.com]
Abdominal Pain
  • Early signs, presenting within the first 6 hours, include abdominal pain, vomiting, diarrhoea and gastrointestinal bleeding.[mjhid.org]
  • Iron causes two major effects Local - Gastrointestinal irritation Abdominal pain Nausea and vomiting Systemic - Cellular toxicity causing multi-organ failure Systemic toxicity may occur with doses greater than 60 mg/kg and is life-threatening with doses[kidshealthwa.com]
  • Stages of Iron Poisoning Stage Time Postingestion Description 1 Within 6 h Vomiting, hematemesis, explosive diarrhea, irritability, abdominal pain, lethargy If toxicity is severe, tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within[merckmanuals.com]
  • Concentration 60 - 90 micromol/L and tablets visible on AXR or symptomatic (nausea, vomiting, diarrhoea, abdominal pain, haematemesis, fever).[rch.org.au]
  • Iron salts are directly toxic to the gastrointestinal tract causing vomiting, diarrhoea, abdominal pain and occasionally significant blood loss.[ncbi.nlm.nih.gov]
Nausea
  • Heart failure can cause swelling of the legs, shortness of breath, trouble exercising, fatigue, fast or irregular heartbeat and nausea.[livestrong.com]
  • Concentration 60 - 90 micromol/L and tablets visible on AXR or symptomatic (nausea, vomiting, diarrhoea, abdominal pain, haematemesis, fever).[rch.org.au]
  • Toxidromes/Toxic Symptoms and Antidotes Type of poisoning Agents Toxidromes/toxic symptoms Antidotes Acetaminophen Acetaminophen Abdominal pain, nausea/vomiting, elevated aspartate transaminase level (greater than 1,000 IU per L after 24 hours), jaundice[aafp.org]
  • Most iron toxicity involves the intestinal tract, ranging from nausea and vomiting to diarrhea and hematemesis.[thefreelibrary.com]
  • Excess of iron may irritate the stomach mucosa giving rise to pain in abdomen, vomiting, nausea, and diarrhea. In case if iron irritates intestinal lining, it can lead to bleeding in stool, and blood vomits.[tandurust.com]
Hematemesis
  • Stages of Iron Poisoning Stage Time Postingestion Description 1 Within 6 h Vomiting, hematemesis, explosive diarrhea, irritability, abdominal pain, lethargy If toxicity is severe, tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within[merckmanuals.com]
  • Severe vomiting associated with hematemesis are suggestive of intoxication.[actagastro.org]
  • GI toxicity includes vomiting, diarrhea, crampy abdominal pain, hematemesis, and melena due to direct mucosal corrosion.[clinicaladvisor.com]
  • Ingested iron can have an extremely corrosive effect on the gastrointestinal (GI) mucosa, which can manifest as nausea, vomiting, abdominal pain, hematemesis, and diarrhea; patients may become hypovolemic because of significant fluid and blood loss.[emedicine.medscape.com]
  • Most iron toxicity involves the intestinal tract, ranging from nausea and vomiting to diarrhea and hematemesis.[thefreelibrary.com]
Jaundice
  • Late symptoms of acute stage consist of low blood pressure, epileptic seizure, liver failure, low blood sugar, jaundice, and intestinal obstruction. The late symptoms may develop in 6 hours to 2 days after its excess consumption.[tandurust.com]
  • Liver failure may occur, causing low blood sugar, excessive or prolonged bleeding and jaundice -- yellowish eyes and skin. It is rare for people with such severe iron toxicity to survive, but those who do enter the fourth stage.[livestrong.com]
  • […] lethargy If toxicity is severe, tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within 6–48 h Up to 24 h of apparent improvement (latent period) 3 12–48 h Shock, seizures, fever, coagulopathy, metabolic acidosis 4 2–5 days Liver failure, jaundice[merckmanuals.com]
  • […] symptoms (sense of recovery) Phase 3 - Cardiogenic shock and acidosis 24-48 hours Hypotension Anion gap metabolic acidosis Shock (may develop from Phase 1) Potential multi-system failure Coma Phase 4 - Hepatic necrosis 2-5 days Acute hepatic failure Jaundice[kidshealthwa.com]
  • Toxidromes/Toxic Symptoms and Antidotes Type of poisoning Agents Toxidromes/toxic symptoms Antidotes Acetaminophen Acetaminophen Abdominal pain, nausea/vomiting, elevated aspartate transaminase level (greater than 1,000 IU per L after 24 hours), jaundice[aafp.org]
Hypotension
  • The child has significant symptoms of altered conscious state, hypotension, tachycardia, tachypnoea, or worsening symptoms irrespective of ingested dose or serum iron concentration.[rch.org.au]
  • Deferoxamine is infused at rates up to 15 mg/kg/h IV, titrated until hypotension occurs. Because both deferoxamine and iron poisoning can decrease BP, patients receiving deferoxamine require IV hydration.[merckmanuals.com]
  • This free iron can damage blood vessels and produce vasodilation with increased vascular permeability, leading to hypotension and metabolic acidosis.[usmleforum.com]
  • Dopamine and norepinephrine can be used if the hypotension persists. Blood component therapy may be needed for those patients with blood loss.[hawaii.edu]
  • The infant had evidence of serious toxicity in the form of hypotension, metabolic acidosis and excessive irritability. Her serum iron levels were 360 µg/dl, which was well above the normal range for her age.[casereports.bmj.com]
Tachycardia
  • The child has significant symptoms of altered conscious state, hypotension, tachycardia, tachypnoea, or worsening symptoms irrespective of ingested dose or serum iron concentration.[rch.org.au]
  • , pyridostigmine Salivation, lacrimation, urination, diarrhea, bronchorrea, wheezing, bradycardia, vomiting Atropine/pralidoxime (not available in the United States) Cholinergic, nicotinic Black widow spider bites, carbamates, insecticides, nicotine Tachycardia[aafp.org]
  • Stages of Iron Poisoning Stage Time Postingestion Description 1 Within 6 h Vomiting, hematemesis, explosive diarrhea, irritability, abdominal pain, lethargy If toxicity is severe, tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within[merckmanuals.com]
  • […] concentration greater than 500 µg/dL (90 µmol/L); persistent serious symptoms such as vomiting, diarrhea, and/or altered mental status; presence of systemic symptoms, including subtle symptoms that can be seen in the latent phase of iron intoxication, such as tachycardia[mjhid.org]
  • […] respiratory depression Otherwise let the patient "sleep off" the benzodiazepines Glucagon β-blockers IM glucagon best to reverse beta-blocker overdose β-blockers (propranolol, esmolol) Theophylline OD symptoms are due to β 2 activation: hypotension, tachycardia[medbullets.com]
Lethargy
  • Irritability and lethargy may also occur. If the toxicity is severe, rapid heartbeat, low blood pressure and rapid breathing may develop.[livestrong.com]
  • Later signs include hypotension, metabolic acidosis, lethargy, seizures, and coma. Hyperbilirubinemia and elevated liver enzymes suggest liver injury, while proteinuria and appearance of tubular cells in urine suggest renal injury.[usmleforum.com]
  • Stages of Iron Poisoning Stage Time Postingestion Description 1 Within 6 h Vomiting, hematemesis, explosive diarrhea, irritability, abdominal pain, lethargy If toxicity is severe, tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within[merckmanuals.com]
  • People with iron poisoning can have the following symptoms: Severe vomiting Diarrhea Abdominal pain Dehydration and lethargy if not treated adequately In a child, bloody vomit or stool Often, after supportive care, the gastrointestinal symptoms appear[webmd.com]
  • ., lethargy, hypotension, and shock) may also be present. Most patients with mild to moderate toxicity do not progress past this stage, and symptoms resolve within 4-6 hours.[clinicaladvisor.com]
Seizure
  • Late symptoms of acute stage consist of low blood pressure, epileptic seizure, liver failure, low blood sugar, jaundice, and intestinal obstruction. The late symptoms may develop in 6 hours to 2 days after its excess consumption.[tandurust.com]
  • Symptoms of the third stage of iron toxicity include low blood pressure, fever and seizures. Liver failure may occur, causing low blood sugar, excessive or prolonged bleeding and jaundice -- yellowish eyes and skin.[livestrong.com]
  • Later signs include hypotension, metabolic acidosis, lethargy, seizures, and coma. Hyperbilirubinemia and elevated liver enzymes suggest liver injury, while proteinuria and appearance of tubular cells in urine suggest renal injury.[usmleforum.com]
  • Vomiting, hematemesis, explosive diarrhea, irritability, abdominal pain, lethargy If toxicity is severe, tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within 6–48 h Up to 24 h of apparent improvement (latent period) 3 12–48 h Shock, seizures[merckmanuals.com]
  • (not available in the United States) Cyanide Cyanide Syncope, cyanosis, hypotension, psychosis Sodium nitrite 3%, sodium thiosulfate 25% Ethylene glycol, methanol Antifreeze, rubbing alcohol Central nervous system depression, respiratory depression, seizures[aafp.org]
Irritability
  • Although moderate amounts of iron may be irritating and may produce diarrhea, larger amounts may cause paralytic ileus. Localized concentrations of iron may then exert corrosive effects and cause segmental infarctions and perforations.[ncbi.nlm.nih.gov]
  • Excess of iron may irritate the stomach mucosa giving rise to pain in abdomen, vomiting, nausea, and diarrhea. In case if iron irritates intestinal lining, it can lead to bleeding in stool, and blood vomits.[tandurust.com]
  • Nervousness and Irritability Iron raises sodium, which can lower calcium, magnesium and zinc levels. This frequently leads to nervousness and irritability.[arltma.com]
  • The infant had evidence of serious toxicity in the form of hypotension, metabolic acidosis and excessive irritability. Her serum iron levels were 360 µg/dl, which was well above the normal range for her age.[casereports.bmj.com]
Stupor
  • He is stuporous and does not respond to questions appropriately, often yelling and falling down. On exam, the patient has visual impairment and cannot read the Snellen chart correctly. Figure A shows his retina on ophthalmologic exam.[medbullets.com]

Workup

Cytopenia
  • According to FDA (May 2007), renal failure and cytopenias have been reported in patients receiving deferasirox oral suspension tablets.[mjhid.org]
Pancreatic Necrosis
  • The organ systems most affected include the gastrointestinal tract, liver, vessels, and occasionally pulmonary damage, renal damage and pancreatic necrosis.[ 4-6 ] In 2005, a review of 70 patients with iron toxicity showed hepatotoxicity in 13 patients[mjhid.org]

Treatment

  • He later recovered after treatment with deferoxamine and good supportive care. This is Taiwan's first reported case of acute iron intoxication in an attempted suicide.[ncbi.nlm.nih.gov]
  • Information is given regarding availability of the drug for clinical use in the treatment of acute iron poisoning.Clinical FeaturesThe clinical features of iron intoxication are summarized in Table 1.[nejm.org]
  • The duration of treatment was advised taking into consideration the patient's clinical status, the serum iron concentration and the LIC levels. The mild symptoms previously reported by the patients disappeared after 4 weeks of treatment.[mjhid.org]
  • In parallel, the possibil ity of influencing free radical related disease processes by antioxidant treatment was studied in various in vitro and in vivo systems.[books.google.com]

Prognosis

  • In one series of patients who presented with cardiomyopathy associated with hemochromatosis, therapeutic phlebotomy improved the prognosis in 70%; untreated patients had a worsening of their condition and mean survival of only one year.[library.med.utah.edu]
  • Acute item poisoning: assessment of severity and prognosis. J Pediatr. 1970;77:117-119. 30. Bentur Y, St Louis P, Klein J, et al. Misinterpretation of iron-binding capacity in the presence of deferoxamine. J Pediatr. 1991;118:139-141. 31.[healio.com]
  • The poorer prognosis associated with hepatic involvement in iron poisoning compared with acetaminophen poisoning may be due to different histologic patterns of injury. (3) Acetaminophen poisoning is associated with a more centrilobular involvement in[thefreelibrary.com]

Epidemiology

  • Iron poisoning: a literature-based review of epidemiology, diagnosis, and management. Pediatric emergency care. 27(10):978-85. 2011. [ pubmed ] Chyka PA, Butler AY. Assessment of acute iron poisoning by laboratory and clinical observations.[lifeinthefastlane.com]
  • Different iron preparations (salts) contain different amounts of elemental iron, as follows: Fumarate - 33% Sulfate - 20% Gluconate - 12% Epidemiology United States The 2017 Annual Report of the American Association of Poison Control Centers' (AAPCC)[emedicine.medscape.com]
  • Adult Blood Lead Epidemiology and Surveillance --- United States, 2002. CDC MMWR [On-line information]. Available online at . Harold E. Hoffman, MD, FRCPC, FACOEM. Occupational & Environmental Medicine. Edmonton, Alberta, Canada. Thomas P.[labtestsonline.it]
  • This article reviews the epidemiology of acute iron poisoning in children, the various formulations of iron, the toxic dose of iron, the clinical presentation and pathophysiology of iron poisoning, and recent changes in evaluating and treating the patient[healio.com]
  • Epidemiology of pediatric poison exposures: an analysis of 2003 poison control center data. Clin Pediatr Emerg Med. 2005;6(2):68–75. 7. Osterhoudt K. The toxic toddler: drugs that can kill in small doses. Contemp Pediatr. 2000;3:73–88. 8.[aafp.org]
Sex distribution
Age distribution

Pathophysiology

  • The clinical history and microscopic findings are consistent with the hypothesis of a direct action of absorbed iron on vascular walls as the pathophysiologic mechanism for the toxic effects of iron on the gastrointestinal tract.[ncbi.nlm.nih.gov]
  • ACCIDENTAL poisoning by iron compounds continues to be a common pediatric problem. 1 2 3 This brief review includes the current thoughts on the pathophysiology of iron poisoning, the results of treatment with a new chelating agent, deferoxamine, in 6[nejm.org]
  • Pathophysiology Iron toxicity can be classified as corrosive or cellular.[emedicine.medscape.com]
  • This article reviews the epidemiology of acute iron poisoning in children, the various formulations of iron, the toxic dose of iron, the clinical presentation and pathophysiology of iron poisoning, and recent changes in evaluating and treating the patient[healio.com]

Prevention

  • Acute intoxication manifestations did not occur probably due to the administration of iron doses over an extended period.[ 11 ] However, it is possible that prompt iron chelation in our case had prevented the cumulative pathological effects of acute and[mjhid.org]
  • CDC Childhood Lead Poisoning Prevention Program, CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children.[labtestsonline.it]
  • Patient 1 had severe iron intoxication, while aggressive treatment prevented severe toxicity in patient 2. Acute iron toxicity includes effects on the GI tract and the cardiovascular, metabolic, hepatic, and central nervous systems.[ncbi.nlm.nih.gov]
  • Measures to prevent toxic ingestions (e.g., child-resistant packages and warning labels) were present in at least four cases described in this report.[cdc.gov]

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