North American Iron poisoning is the leading cause of fatal poisoning in children. The symptoms begin with acute gastroenteritis; after a symptom-poor to -free interval leads to shock and liver failure. The diagnosis is made by determining the concentration of iron in serum by detection radiopaque iron tablets in the gastrointestinal tract or by the presence of unexplained metabolic acidosis in patients with other findings, which suggest an iron poisoning. When recording a larger amount of substance treatment with an enema, and a chelation therapy with deferoxamine is done i.v.
Many of the usual non-prescription medicines contain iron. Of the many iron compounds that are used in non-prescription and prescription preparations are the most common:
North American Iron poisoning is the leading cause of fatal poisoning in children. The symptoms begin with acute gastroenteritis; after a symptom-poor to -free interval leads to shock and liver failure. The diagnosis is made by determining the concentration of iron in serum by detection radiopaque iron tablets in the gastrointestinal tract or by the presence of unexplained metabolic acidosis in patients with other findings, which suggest an iron poisoning. When recording a larger amount of substance treatment with an enema, and a chelation therapy with deferoxamine is done i.v. Many of the usual non-prescription medicines contain iron. Of the many iron compounds that are used in non-prescription and prescription preparations are the most common: ferrous sulfate (20% elemental iron) ferrous gluconate (12% pure elemental iron) ferrous fumarate (33% elemental iron) for children to iron tablets look like candy. Multivitamins for pregnancy are the leading cause of fatal poisoning in children iron. Chewable multivitamins for children contain as little iron in the rule that intoxication is rarely observed. Pathophysiology iron is toxic to the gastrointestinal tract, the cardiovascular system and the central nervous system. The specific pathological mechanism is unclear, but excess iron is introduced into enzymatic processes that interfere with oxidative phosphorylation and thus leads to a metabolic acidosis. Iron catalyzes the formation of oxygen free radicals and acts as an oxidizing agent. , It connects when the plasma protein binding is saturated with water to form iron hydroxide and free H + ions and thus enhances the metabolic acidosis. A coagulopathy based in the early phase of an interference with the coagulation cascade, in the late phase, this is due to liver damage. The toxicity is dependent upon the amount of elemental iron, which was taken. Up to 20 mg / kg of elemental iron are non-toxic; 20-60 mg / kg are mild to moderately toxic, and> 60 mg / kg can cause severe disease. Symptoms and complaints The clinical picture of an iron poisoning shows a 5-phase progression (see Table: phases of the iron poisoning); but can vary greatly symptoms and course. The clinical severity in Phase 1 are usually the severity of total poisoning again; Late symptoms develop only if the symptoms moderate in Phase 1 or is severe. If not develop symptoms within the first 6 hours after intake of poison, the risk of serious poisoning is minimal. If develop within the first 6 hours shock and coma, the mortality rate is about 10%. Phases of the iron poisoning phase time after taking Description 1 Within 6 h vomiting, hematemesis, explosive diarrhea, irritability, abdominal pain, lethargy, if the toxicity is severe: tachypnea, tachycardia, hypotension, coma, metabolic acidosis 2 Within 6-48 h bis to 24 hours of the apparent improvement (latency) 3 12-48 h shock, cramping, fever, coagulopathy, metabolic acidosis 4 2-5 days liver failure, jaundice, coagulation disorders, hypoglycemia 5 2-5 weeks gastric or duodenal obstruction due to scarring diagnostic X-ray image of the abdomen determination of serum iron, electrolytes and pH value 3-4 hours after ingestion A iron poisoning should always be considered when children with access to iron develop an unexplained metabolic acidosis, a serious or hemorrhagic gastroenteritis. Because children often share, the siblings and playmates of children should also be examined with an iron ingestion. Usually an x-ray of the abdomen is recommended to determine an oral iron absorption; Iron tablets and Tablettenverklumpungen are well recognized, however, bitten and dissolved tablets, liquid iron supplements and iron-containing multivitamin supplements do not come to represent. Serum iron, electrolytes, and pH are determined 3-4 hours after intake of poison. Toxicity is assumed when there is suspicion of taking one of the following findings is accompanied vomiting and abdominal pain serum iron concentration, although suggestive of poisoning> 350 ug / L (63 mol / L) of iron visible metabolic on radiograph Unexplained acidosis The iron concentrations above can, but the iron concentration alone tells about the severity of the poisoning of anything yet. The total iron binding capacity is often inaccurate and not helpful to diagnose a severe poisoning; their determination is therefore not recommended. The most suitable approach is the repeated measurement of serum iron concentration of HCO3- and pH (with calculation of the anion gap); These findings are then evaluated together and correlated with the clinical picture of the patient. Poisoning occurs when increasing concentrations of iron, metabolic acidosis, worsening of clinical symptoms or, more typically, a combination is observed all these findings. Clinical Calculator: anion gap colonic irrigation therapy in severe toxicity: iv Deferoxamine If radiopaque tablets are visible in the abdominal X-ray, an intestinal lavage with polyethylene glycol in a dose of 1-2 l / h in adults or children’s dose of 25-40 ml / kg / h is carried out, until, at a repetition of the X-rays is the abdomen to see any more iron. Administration through a nasogastric tube may be necessary to deliver these large quantities. It should be very on the protection of the respiratory tract, if necessary an intubation displayed (see tracheal intubation). Gastric lavage is not usually helpful, vomiting hand, seems to empty the stomach effectively. Activated carbon does not bind iron and should only be given if other toxins were ingested. All patients who have more than a slight gastroenteritis are hospitalized. Patients with severe poisoning (metabolic acidosis, shock, severe gastroenteritis, or serum iron concentrations> 500 ug / dL) can be treated with intravenous deferoxamine to bind the free serum iron as chelate. Deferoxamine is infused at a rate of up to 15 mg / kg / h and until blood pressure falls. Since both deferoxamine and the iron poisoning can lower blood pressure, require patients receiving deferoxamine, adequate hydration. Summary Doe toxicity of iron, vergleichabr other liver toxins can cause gastroenteritis, which is followed by an asymptomatic phase of shock and liver failure. An iron poisoning should always be considered when children with access to iron develop an unexplained metabolic acidosis, a serious or hemorrhagic gastroenteritis. A suspected of serious iron poisoning occurs when steigendeSerum- iron concentrations, metabolic acidosis, worsening of clinical symptoms present or, more typically, a combination of all of these findings is observed. An intestinal purging is provided made up on X-rays to detect any more iron. Deferoxamine i.v. is given in severe poisoning (z. B. metabolic acidosis, shock, severe gastroenteritis, serum iron level> 500 ug / dL).