Accidental iron poisoning in children - Experience from a teaching institution

• Published in: Journal of family medicine and primary care Vol. 12; no. 10; pp. 2520 - 2523
• Main Authors: Chandran, Jolly, Sanketh, R, Vyasam, Siva, Chrysolyte, Asha, Ebenezer, Kala
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01-10-2023; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: desferrioxamine; Drugs; fulminant hepatic failure; iron ingestion; Overdose; Pediatrics; Plasma exchange (Therapeutics); plasmapheresis; India; Desferrioxamine; fulminant hepatic failure; plasmapheresis; iron ingestion
• ISSN: 2249-4863; 2278-7135
• DOI: 10.4103/jfmpc.jfmpc_805_23

Background: Acute iron toxicity is fatal in children resulting from an accidental overdose of maternal iron tablets at home. There is scanty literature on children looking at the profile and outcome. We report a case series of five children presenting after accidental ingestion of iron tablets. Two presented with fulminant hepatic failure at 48 h, and despite supportive management and plasmapheresis in one child, both succumbed to illness. Materials and Methods: This retrospective study was conducted in the pediatric intensive care unit (PICU) of a teaching institution in South India between January 2009 and December 2019. All children with accidental iron poisoning were included in the analysis. Results: During the study period, five children presented to our PICU after accidental iron tablet ingestion. The mean age was 25.8 months [standard deviation (SD): 13.9]. All the children had consumed iron tablets from their pregnant mothers. Two children presenting with liver failure succumbed to illness. Treatment included a standard protocol of gastric lavage and desferrioxamine. Most of them (3/5) received whole bowel irrigation. We did plasmapheresis in one child who presented with fulminant hepatic failure. The majority were discharged alive (3/5). The presence of coagulopathy, acute liver failure, and delayed presentation were associated with high mortality. Conclusion: Accidental iron poisoning is prevalent in children and associated with significant mortality. Parents and caretakers must be counseled by primary care physicians and made aware of the safe storage of iron tablets.