injuries poisoning
Iron Poisoning
Diagnosis of Iron Poisoning
Abdominal x-ray Determination of serum iron, electrolytes, and pH 3 to 4 hours after ingestion Iron poisoning should be considered in mixed ingestions (because iron is ubiquitous) and in small children with access to iron and unexplained metabolic acidosis or severe or hemorrhagic gastroenteritis. Because children often share, siblings and playmates of small children who have ingested iron should be evaluated. Abdominal x-ray is usually recommended to confirm ingestion; it detects intact iron tablets or iron concretions but misses chewed and dissolved tablets, liquid iron preparations, and iron in multivitamin preparations. Serum iron, electrolytes, and pH are determined 3 to 4 hours after ingestion. Toxicity is assumed if suspected ingestion is accompanied by any of the following: Vomiting and abdominal pain Serum iron levels>350 mcg/dL (63 micromol/L) Iron visible on x-ray Unexplained metabolic acidosis These iron levels may indicate toxicity; however, iron levels alone do not predict toxicity accurately. Total iron binding capacity is often inaccurate and not helpful in diagnosing serious poisoning and is not recommended. The most accurate approach is to serially measure levels of serum iron, bicarbonate, and pH (with calculation of the anion gap); these findings are then evaluated together, and results are correlated with the patient’s clinical status. For example, toxicity is suggested by increasing iron levels, elevated anion gap metabolic acidosis, worsening symptoms, or, more typically, some combination of these findings. Thedeferoxaminechallenge test is no longer recommended for evaluation of possible iron overdose because of poor sensitivity. In this test,deferoxamine, an iron chelating agent, was given intramuscularly, and serial urine samples were evaluated for the characteristic orange or reddish brown color (vin rosé urine) caused by excreted ferrioxamine). 