Toddler : Safety promotion and injury prevention : Iron

          • Iron
            • Items
              • Mineral supplement or vitamin containing iron
            • Clinical Manifestations
              • 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)
                  • Vomiting
                  • Hematemesis
                  • Diarrhea
                  • Hematochezia (bloody stools)
                  • Abdominal pain
                  • Severe toxicity may have tachypnea, tachycardia, hypotension, coma
                • Latency (up to 24 hours)
                  • Patient improves
                • Systemic toxicity (12 to 24 hours after ingestion)
                  • Metabolic acidosis
                  • Fever
                  • Hyperglycemia
                  • Bleeding
                  • Seizures
                  • Shock
                  • Death (may occur)
                • Hepatic injury (2 to 5 days)
                  • Jaundice
                  • Liver failure
                  • Coma
                • Rarely pyloric stenosis develops at 2 to 5 weeks
            • Comments
              • Factors related to frequency of iron poisoning:
                • Widespread availability
                • 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.
            • Treatment
              • 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.