Pe

Labs

Imaging

Gross Pathology Micro Pathology Treatment

Discussion

A 9-year-old male is brought to the emergency room after intentionally ingesting half a bottle of iron tablets (coated with plum-flavored sugar) six hours ago; he now complains of abdominal pain.

I Ie has been feeling weak and lightheaded, with palpitations and a metallic taste in his mouth. He had two episodes of bluish-green vomit followed by a large hematemesis.

VS: marked tachycardia (HR 120); hypotension (BP 90/50); no fever. PE: pulse weak, patient is pale and dehydrated with cold and clammy skin; lungs clear; abdomen tender to deep palpation, predominantly in epigastrium, wilh no peritoneal signs; neurologic exam normal; rectal exam discloses black, tarry stool.

Markedly elevated serum iron levels (> 500 mg/dL). UA: rose-wine-colored urine. ABGs: metabolic acidosis. BUN and creatinine elevated.

XR-Abdomen: multiple radiopaque iron tablets in G1 tract from stomach to jejunum. Endoscopy: diffuse hemorrhagic gastritis with extensive necrosis and sloughing of mucosa.

Gastric lavage with bicarbonate solution (to form ferrous carbonate, which is not absorbed well) or induction of vomiting. Treat acidosis, treat shock with IV fluids and chelation therapy with deferoxamine.

Mortality due to acute iron overdose may reach 25% or more, mainly in children. There may be marked dehydration and shock.

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