Toddler : Safety promotion and injury prevention : Iron
Mineral supplement or vitamin containing iron
Occurs in five stages (may have significant variation in symptoms and their progression):
Within 6 hours after ingestion (if child does not develop gastrointestinal symptoms in 6 hours, toxicity is unlikely)
Hematochezia (bloody stools)
Severe toxicity may have tachypnea, tachycardia, hypotension, coma
Latency (up to 24 hours)
Systemic toxicity (12 to 24 hours after ingestion)
Death (may occur)
Hepatic injury (2 to 5 days)
Rarely pyloric stenosis develops at 2 to 5 weeks
Factors related to frequency of iron poisoning:
Packaging of large quantities in individual containers
Lack of parental awareness of iron toxicity
Resemblance of iron tablets to candy (e.g., M&M’s)
Toxic dose is based on the amount of elemental iron ingested. Common preparations include ferrous sulfate (20% elemental iron), ferrous gluconate (12%), and ferrous fumarate (33%). Ingestions of 20 to 60 mg/kg are considered mildly to moderately toxic, and >60 mg/kg is severely toxic and may be fatal.
Hospitalization is required when more than mild gastroenteritis is present.
Use whole bowel irrigation if radiopaque tablets are visible on abdominal x-ray; may need to be given via nasogastric tube.
Emesis empties the stomach more effectively than lavage.
Chelation therapy with deferoxamine is used in severe intoxication (may turn urine a red to orange color).
If intravenous deferoxamine is given too rapidly, hypotension, facial flushing, rash, urticaria, tachycardia, and shock may occur; stop the infusion, maintain the intravenous line with normal saline, and notify the practitioner immediately.