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Acute poisoning may occur following accidental, unintentional, or inadvertent ingestion of medications that contain iron. Although acute iron poisoning occurs relatively infrequently, pediatricians should be aware of the presentation and treatment of iron poisoning. The management of acute iron poisoning has changed significantly over the past several years. This article reviews the epidemiology of acute iron poisoning in children, the various formulations of iron, the toxic dose of iron, the clinical presentation and pathophysiology of iron poisoning, and recent changes in evaluating and treating the patient.
DEMOGRAPHICS
Acute iron poisoning is primarily a pediatric phenomenon. In 1993, the American Association of Poison Control Centers reported 24,209 cases of exposure to iron-containing products, of which 84% occurred in children younger than 6 years of age and 10% in children 6 to 19 years of age.1 In 1993, iron exposures accounted for 2.2% of all exposures in children younger than 6 years of age. Interestingly, this percentage has not changed much during the past decade; since 1984, iron has accounted for an average of 2% of all exposures in children 6 years of age and younger (Figure I).1-10
Iron-containing products can be divided into three therapeutic classes: adult iron supplements, adult vitamins with iron, and pediatric vitamins with iron. Table 1 demonstrates the 1993 distribution of exposures to these classes of medications by age group.1 Fortunately, most of these exposures are relatively benign. The outcomes of these cases (including the adults) were classified as none or minor in 90.5%, moderate in 8.5%, major in 0.9%, and death in 0.1%. Of the five fatal cases in 1993, three occurred in children younger than age 6. For this age group, this represents a fatality rate (fatalities/exposure) of 0.038%.
It is interesting to note that serious morbidity has risen steadily from 1984 to 1993 (Figure 2) while the mortality rate (Figure 3) generally has remained steady (except for the years 1990 through 1992).110 The extraordinarily high mortality rates in 1990 (0.063%), 1991 (0.122%), and 1992 (0.074%) have not been explained. The cause of these deaths has been attributed to adult iron formulations. Aggregate data from the American Association of Poison Control Centers demonstrates that 74% of fatalities in young children occurred following the ingestion of adult iron supplements with the...