PEDIATRICS SEMINAR PRESENTATION

TOPIC;IRON INTOXICATION IN CHILDREN

BY

M.S.PRAYTHIESH BRUCE,

FINAL MBBS,SMIMS,

KULASEKARAM

IRON INTOXICATION IN CHILDREN

• IRON IS A ESSENTIAL NUTRIENT THAT IS COMMON CONTENT OF VITAMIN PREPARATIONS AND TONICS

• IRON POISONING IS A PEDIATRIC EMERGENCY• ONE OF THE TOP 10 SUBSTANCES INGESTED BY

CHILDREN LESS THAN 5 YEARS• CHRONIC IRON INTOXICATION OCCUR DUE TO

REPEATED BLOOD TRANSFUSION AND THALASSEMMIA

ACCIDENTAL POISONING OF IRON IN CHILDREN

• OCCUR DUE TO ;• FREQUENT IRON SUPPLEMENTS FOUND IN

MANY HOMES• UNAWARENESS OF PEOPLE THAT IRON CAN

BE DANGEROUS• ATTRACTIVENESS OF IRON TABLETS• ILLETERACY AND CARELESSNESS OF PATIENT•

PATHOPHYSIOLOGY OF IRON POISONING

TOXIC DOSES

• LOWEST LETHAL DOSE OF IRON IS 600MG• 20MG/KG SUB TOXIC• 20-60MG/KGBODY WEIGHT –MILD SYMPTOMS• >60MG/KG BODY WEIGHT-POTENTIALLY LETHAL

CLINICAL FEATURES• VOMITING,ABDOMINAL PAIN• CRAMPS,HEMATEMESIS,DIARRHOEA,CIR

CULATORY FAILURE,JAUNDICE(2-4 DAYS LATER)

CLINICAL FEATURES OF IRON I INTOXICATION• GASTROINTESTINAL STAGE;30MIN-2HOURS• APPARENT RECOVERY;2-6HOURS• CIRCULATORY FAILURE;12 HOURS• HEPATIC NECROSIS;2-4 DAYS• GASTRIC SCARRING-2-4 WEEKS

DEFINITIVE TREATMENT OF IRON INTOXICATION• CHELATING AGENT;DESFERRIOXAMINE• INDICATIONS;• LETHARGHY,TACHYPNEA,TACHYCARDIA• HYPOTONIA • FREE SERUM IRON IS MORE THAN 50UG/DL• TOTAL SERUM IRON >350UG/DL• LEUCOCYTE COUNT MORE THAN 15,000CUMM• SERUM GLUCOSE>150MG/DL

ROUTE AND DOSAGE OF DESFERRIOXAMINE . .

• ACUTE CASES IV INFUSION• LESS SEVERE CASES IM• I5MG/KG/HR IV AND 50MG/KG GIVEN EVERY 4 HOURS IM• TOTAL DOSE SHOULD NOT EXCEED 6GM IV OR IM• PREPARATION AVAILABLE;POWDER FORM IN VIAL

5OOMG WHICH DILATED IN WATER FOR INJECTION TO HAVE 10 %SOLUTION

• SOLUTION IS DILUTED IN 0.8%SALINE IN 5%DEXTROSE

• FOR CONTINOUS IV ADMINISTRATION

INVESTIGATIONS;

• PLAIN XRAY OF ABDOMEN• FREE SERUM IRON>50MG/DL• TOTAL SERUM IRON>350MG/DL• LEUCOCYTOSIS

MANAGEMENT OF IRON INTOXICATION IN CHILDREN

• EMESIS WITH SYRUP IPECAC• GASTRIC LAVAGE• SUPPORTIVE AND SYMPTOMATIC TREATMENT• CHELATION THERAPHY• DIALYSIS WITH CHELATION • VERY SEVERE CASES ;EXCHANGE TRANSFUSION• CHARCOAL HEMOPERFUSION WITH SIMULTANEOUS

CHELATION

THANK YOU