Iron Toxicity

General Illness Information

Common Name: Iron poisoning

Medical Term: Iron Toxicity, Iron Overload

Description:

Iron is a part of many vitamins for adults and children, so light cases of iron overdose are very frequent. However, a severe overdose of iron can be dangerous and even fatal. Children’s vitamins containing iron are safe because of the limited number of tablets in the package.

Not all iron preparations are the same. Taking several iron tablets for adults can harm a child. Iron poisoning is the main cause of death from poisoning in children.

Many over-the-counter products contain iron. Among these and prescription drugs containing iron, iron sulfate (20% pure iron), iron gluconate (12% pure iron) and iron fumarate (33% pure iron) are most often found. Children can take tablets containing iron for candy. Multivitamins for pregnant women contain iron and very often cause deadly poisoning in children.

Iron is toxic to the digestive tract, central nervous system and cardiovascular system. The specific mechanism is unclear, but excess amounts of free iron are involved in enzymatic processes and disrupt oxidative phosphorylation, causing metabolic acidosis. Iron also catalyzes the formation of free radicals, acting as an oxidant, when the plasma protein bonds are saturated, iron and water form iron hydroxide and free H + ions, which also aggravates metabolic acidosis. Coagulopathy can appear both in the early period due to disturbances in the cascade of coagulation, and later due to liver damage. The content of pure iron <20 mg / kg is non-toxic; 20-60 mg / kg causes moderate poisoning, and> 60 mg / kg can cause severe poisoning and complications.

Causes:

Often children receive an increased dose of iron-containing medication by accident, adults can be poisoned by medicine and deliberately.

Signs & Symptoms

The signs of acute poisoning are rapidly developing for several hours. In some cases, the symptoms of the disease are limited to diarrhea and nausea – this indicates that the body was able to neutralize the bulk of the dose exceeding the trace element. If the body does not cope with iron poisoning, the disease proceeds in a different scenario, which includes 4 main stages with various symptoms.

The first stage

The first stage lasts about 6 hours. Most symptoms are associated with a gastrointestinal lesion. The most common signs: a violation of the gastrointestinal tract and seizures. Hemorrhagic gastritis is particularly dangerous. Bleeding from the stomach is possible.

In this case, the central nervous system suffers. During the first stage of poisoning, there are irritability and drowsiness, the number of heartbeats gradually decreases, and blood pressure decreases. As a result, a person loses consciousness, and this is already one of the most unfavorable clinical signs in this disease.

The second stage

The second stage lasts much longer – for about 12 hours. The patient feels well, his well-being is improved. Symptoms abate or disappear. Unfortunately, in most cases the improvement is false: an overdose of iron continues to adversely affect the body.

The third stage

The third stage can last up to 48 hours. Blood pressure drops sharply, blood flow decreases. If you pass the tests during this period, they can show the normal level of trace elements, while the sugar will be lowered. Also, signs of liver damage can be detected. In some cases, the temperature rises, the mucous membranes and some internal organs begin to bleed. Among other signs – jaundice, disorientation, anxiety and cramps. The main impact at this stage is on the kidneys, lungs and liver, heart work suffers.

The fourth stage

This stage is the longest – up to several months. During this stage, the pylorus of the gatekeeper or small intestine is formed, this pathology develops because of the healing of ulcers that were formed under the action of the corrosive properties of iron on the mucous membrane.

Diagnosis & Treatment

General Measures:

First aid

First aid should be provided immediately when there are signs of poisoning, even if you do not know what substance affected the development of an acute condition. It is necessary to take several steps:

Rinse the stomach with clean water. To achieve this, you need to drink a few glasses of water and induce vomiting.

You can induce vomiting by drinking Ipecacuania syrup, which irritates the vomiting center.

If you know that poisoning occurred precisely with the use of high doses of iron, then after washing the stomach, you should take 1% sodium bicarbonate in a volume of 50-100 ml. This drug converts iron to iron bicarbonate, which has less irritant effect.

If the patient’s condition is severe and there is no consciousness, then it is necessary to ensure the patency of the airways.

Hospital treatment

If any poisoning is detected, it is necessary to call an ambulance in any case. Only a qualified specialist can decide whether the patient needs to be taken to hospital or can stay at home to achieve a normal condition.

After hospitalization, an overview radiograph of the abdomen is performed. Iron does not miss X-rays and therefore tablets containing iron are visible on the picture. During the treatment, control pictures are taken, which are also indicators of the success of the withdrawal of drugs from the body.

In addition, blood is examined. If X-ray examination shows that after washing the tablets still remain in the stomach, then it is necessary to re-wash it, it also affects the quality of therapy.

The best treatment of iron poisoning is Deferoxamine. Its intravenous administration is indicated in an overdose of iron, followed by:

  • Metabolic acidosis;
  • Multiple vomiting;
  • Symptoms of intoxication;
  • The phenomena of shock;
  • The excess of serum iron in the blood.

Deferoxamine leads to a decrease in blood pressure, which, together with the effect of iron, is highly undesirable. Therefore, this drug is prescribed only on strict indications and is canceled immediately after the resolution of metabolic acidosis.

Medical treatment of iron poisoning is also based on the severity of the symptoms. In hypotension, colloidal solutions should be used. Exchange acidosis is corrected by intravenous injection of sodium bicarbonate preparations.

In blood coagulability caused by liver damage, vitamin K and fresh frozen plasma are prescribed.

The effectiveness of the therapy is estimated by reducing the concentration of iron in the serum and closer to normal by the color of the urine.

The effect of hemodialysis and the use of exchange blood transfusions for poisoning with iron-containing drugs is insignificant. Activated carbon is not used as an antidote – this drug does not bind the components of iron.

Acute iron poisoning occurs rarely, but if you use iron-containing drugs, you must ensure that they are inaccessible to small family members and elderly relatives with mental problems.

Chronic poisoning can be caused by prolonged medication, so it is necessary to take it only on strict indications and not exceeding the dosage prescribed by the doctor.

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