Iron poisoning is a critical concern in the field of
toxicology, often resulting from excessive iron intake. It primarily affects young children and is a leading cause of fatal poisoning in this age group. Understanding the mechanisms, symptoms, and treatments of iron poisoning is essential for healthcare professionals.
What Causes Iron Poisoning?
Iron poisoning typically occurs due to an overdose of iron supplements, which are commonly used to treat
iron deficiency anemia. Accidental ingestion by children, who might mistake iron supplements for candy, is a frequent cause. Additionally, excessive intake can occur in adults who self-prescribe iron supplements without medical guidance.
How Does Iron Poisoning Affect the Body?
Once ingested, excess iron is absorbed in the gastrointestinal tract. When the body's iron storage capacity is overwhelmed, free iron circulates in the bloodstream, causing oxidative stress and damage to cellular structures. This can lead to systemic toxicity affecting multiple organs, including the liver, heart, and brain. The toxicity is primarily due to the generation of
free radicals, which induce lipid peroxidation and cell injury.
Gastrointestinal Phase: Within the first 6 hours post-ingestion, symptoms like nausea, vomiting, diarrhea, abdominal pain, and gastrointestinal bleeding occur.
Latent Phase: A deceptive improvement in symptoms occurs between 6 to 24 hours post-ingestion. However, systemic toxicity continues to develop.
Metabolic Acidosis and Shock: Between 12 to 24 hours after ingestion, metabolic acidosis, shock, hypoperfusion, and neurotoxicity may manifest.
Hepatotoxicity: Liver damage occurs 2 to 3 days post-ingestion, potentially leading to hepatic failure.
Bowel Obstruction: Scar tissue formation can cause gastrointestinal obstruction weeks after the initial ingestion.
How Is Iron Poisoning Diagnosed?
Diagnosis of iron poisoning involves a combination of clinical assessment and laboratory tests. A history of iron ingestion, coupled with characteristic symptoms, guides initial diagnosis. Laboratory investigations include measuring serum iron concentration, which is crucial for confirming iron toxicity. Additional tests such as complete blood count, liver function tests, and assessment of
anion gap are also performed to evaluate the extent of systemic damage.
Gastrointestinal Decontamination: Gastric lavage or whole bowel irrigation may be performed if the patient presents within hours of ingestion.
Supportive Care: This includes fluid resuscitation, correction of metabolic acidosis, and management of shock.
Chelation Therapy: The administration of
deferoxamine is crucial for chelating free iron and enhancing its excretion. Indications for chelation include high serum iron levels, severe symptoms, or evidence of systemic toxicity.
What Are the Long-term Effects of Iron Poisoning?
Survivors of severe iron poisoning may experience long-term complications, such as liver dysfunction, gastrointestinal strictures, and neurocognitive deficits. Early intervention and appropriate management are key to minimizing these outcomes.
Childproof Packaging: Ensuring that iron supplements are stored in child-resistant containers can prevent accidental ingestion.
Public Awareness: Educating parents and caregivers about the dangers of iron supplements and appropriate dosing is critical.
Prescription Regulations: Limiting over-the-counter availability and advocating for proper prescription practices can reduce the risk of misuse.
In conclusion, iron poisoning is a preventable yet potentially fatal condition. Awareness and adherence to preventive measures, timely diagnosis, and appropriate treatment are vital components in reducing the incidence and impact of iron poisoning.
