SAQ 229 – Paediatric Toxicology – iron ingestion

Question 9. iron ingestion.

a. Risk assessment

• Patient weight and estimated elemental-iron dose in mg/kg.
• Gastrointestinal symptoms, especially vomiting, diarrhoea, abdominal pain, or haematemesis/melaena.
• Clinical indicators of shock or systemic toxicity.

b. Serum iron levels

• Confirm ingestion.
• Peak at approximately four to six hours after ingestion.
• There is no perfect correlation with toxicity, but levels above 90 micromol/L predict systemic toxicity.

c. Investigations

• Blood gas for anion-gap metabolic acidosis.
• Abdominal x-ray for retained radiopaque tablets.
• Blood glucose.
• Full blood count.
• Coagulation profile.
• Liver function tests.
• Erect chest x-ray if perforation is suspected.

d. Decontamination

• Whole-bowel irrigation.

e. Whole-bowel irrigation indications

• Symptomatic ingestion.
• Estimated dose over 60 mg/kg.
• Tablets visible on abdominal x-ray.

f. Antidote

• Desferrioxamine.

g. Antidote indications

• Systemic toxicity.
• Altered consciousness, hypotension, tachycardia, or tachypnoea.
• Serum iron above 90 micromol/L at four to six hours.