Document Type : Original Article

Authors

1 Shahid Beheshti University of Medical Sciences

2 Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Department of Clinical Toxicology, Loghman-Hakim General Teaching Hospital Poison Center, Faculty of Medicine, Toxicological Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran

Abstract

Background: The present study was conducted to determine the prevalence of acute iron poisoning among patients in a referral poison control center located in Tehran. It also studied their clinical profile, treatment, and outcome.
Methods: This retrospective cross-sectional study was conducted on acute iron poisoned patients, who were admitted to the poison center from March 21, 2015 to March 19, 2020. Some background variables such as age, gender, ingested dose, time interval between onset of poisoning to hospital admission, the need for antidote, clinical presentations, paraclinical findings and outcome of poisoning were extracted from patients’ medical records. Data analysis was carried out using SPSS software. 
Results: A total of 74 patients with acute iron poisoning with a mean age of 16.85 ± 11.97 years included in this study. Sixty-one (82.4%) patients were female and the most affected age group was 19-30 years (35.1%). The ingestion dose median in patients under 18 years old was 2450 (IQR=5600, Min= 120, Max= 30000) mg and in the group over 18 years old it was 9000 (IQR= 11125, Min= 600, Max= 30000) mg. Vomiting (66.2%) and lethargy (24.3%) were the most common clinical presentations on admission. Metabolic acidosis was the most common abnormality in blood gas analysis (43.2%). Positive findings in abdominal radiography have been observed in 4 (5.4%) cases. The serum iron concentration in the patients were 259.54 ± 153.96 μg/dL. Moreover, mortality was reported in one case (1.3%). There was a significant difference between the age of the patients whom received deferoxamine and more patients under 18 years of age received the antidotal therapy (p=0.003).
Conclusion: The present study showed a low mortality rate among the acute iron poisoning patients. From this view, it can be concluded that adults have lower mortality rates than children.
 
 

Keywords

  1. Muñoz M,  Villar I,  García-Erce JA. An update on iron physiology. World J Gastroenterol. 2009;15(37):4617-26.
  2. Valerio LG. Mammalian iron metabolism. Toxicol Mech Methods. 2007;17(9):497-517.
  3. Fine JS. Iron poisoning. Curr Probl Pediatr. 2000;30(3):71-90.
  4. Bhanot R, Jain NP, Midha V, Gupta S. Fatal iron toxicity in adults. Tropical Gastroenterology. 2019;38(4):250–2.
  5. Tenenbein M. Toxicokinetics and toxicodynamics of iron poisoning. Toxicology Letters. 1998; 102–103: 653-56.
  6. Crofton AC, Harris K, Wylie C, Isoardi KZ. Unintentional paediatric iron poisoning: A retrospective case series. Emerg Med Australas. 2021;33(6):1044-48.
  7. Rahmani AH, Molavinia SH, Boustani F. Prevalence of symptoms in patients poisoned with iron in Ahvaz Razi Hospital in 2014-2017. Asia Pac J Med Toxicol. 2020; 9(3): 104-7.
  8. Ramachandra SaneM Malukani K Kulkarni RVarun A. Fatal iron toxicity in an adult: clinical profile and review. Indian J Crit Care Med. 2018;22(11):801-3.
  9. Abhilash KPP,  Arul JJ,  Bala D. Fatal overdose of iron tablets in adults. Indian J Crit Care Med. 2013;17(5):311-3.
  10. Skoczynska A,  Kwiecinska D,  Kielbinski M,  Lukaszewski M. Acute iron poisoning in adult female. Hum Exp Toxicol. 2007;26(8):663-6.
  11. Haghighat M, Moravej H, Moatamedi M. Epidemiology of pediatric acute poisoning in southern Iran: a hospital-based study. Bull Emerg Trauma.2013; 1(1): 28–33.
  12. AzizpourYAsadollahiK, Sayehmiri K Kaikhavani SAbangah G. Epidemiological survey of intentional poisoning suicide during 1993-2013 in Ilam Province, Iran. BMC Public Health. 2016;16(1):902.
  13. Singhi SC,  Baranwal AK, Jayashree M. Acute iron poisoning: Clinical picture, intensive care needs and outcome. Indian Pediatr. 2003;40(12):1177-82.
  14. ValentineKMastropietro C, Sarnaik AP. Infantile iron poisoning: challenges in diagnosis and management. Pediatr Crit Care Med. 2009;10(3):e31-3.
  15. Burkhart KK, Kulig KW, Hammond KB, Pearson JR, Ambruso D, Rumack B. The rise in the total iron-binding capacity after iron overdose. Ann Emergency Med. 1991;20(5):532–5.