Pediatric Poisonings and Iron Toxicity

Differences in toddler ingestions from adolescents or adults

• Typically only one substance involved

• Usually a small amount

• Without suicidal intent

Describe characteristics of pediatric poisonings: Peak age 1-3 years

• Children are curious and exploring the environment

• Have hand to mouth and imitative behaviors

Describe characteristics of pediatric poisonings: Types of ingestants

• Young children:

  • cosmetics, household products, toothpaste, medication/poisons that look like candy

• Adolescents:

  • Rx opioids, antidepressants, designer drugs

Substances with unusual reactions not seen in adults or adolescents

Neonates or children

• Benzyl alcohol: gasping syndrome

• Chloramphenicol: grey baby syndrome

• Ethanol: hypoglycemia

• Imidazolines and clonidine: CNS depression

Stage 1 of iron toxicity

Stage 1: 0-6 hrs (if no GI symptoms by 6 hrs → pretty sure that it is not iron toxicity)

• N/V

• Abdominal pain

• Diarrhea

• Intestinal ulceration

• Absence of symptoms in the first 6 hrs almost always excludes serious iron toxicity

Stage 2 of iron toxicity

Stage 2: 6-12 hrs

• “Latent” stage

• Initial GI symptoms have resolved but ongoing cellular toxicity and organ damage occurring

Stage 3 of iron toxicity

Stage 3: 12-24 hrs

• “Shock” stage

• Shock

• Lactic acidosis

• CNS effects

Stage 4 of iron toxicity

Stage 4: 2-3 days

• Hepatic failure

Stage 5 of iron toxicity

Stage 5: 2-8 weeks

• GI obstruction, strictures

Management for iron toxicity

• Send in for evaluation: ANYONE that is suspected to have ingested >40 mg/kg of elemental iron or symptomatic

• Initial stabilization: airway assessments (ABCs) and IV access

• Abdominal radiograph

• GI decontamination

  • Activated charcoal does NOT adsorb the iron!

  • Whole body irrigation can be considered when appropriate

• Lab workup

  • Metabolic panel

  • AGAP

  • Lactate

  • ABG or VBG

  • CBC

  • LFT

  • Coagulation panel

  • Serum iron concentration

deferoxamine

Antidote treatment

• Specific chelator for iron → complexes with ferric iron which is excreted by the kidneys in the urine

• Dosing: 15 mg/kg/hr IV

  • Max is 6-8 grams/24 hr

Identify appropriate clinical references for the management of poisonings

• Lexi Drug Toxicology 

• Micromedex (Poisondex)

• Olson’s Posioning and Drug Overdose

• Call the Poison Center!

ADE of deferoxamine

• anaphylactoid rxn

• hypotension

• acute respiratory distress syndrome

• pulmonary edema

• infection (yersinia sepsis)