Emergency medicine residents and medical students on emergency medicine rotations.
Iron overdose is an uncommon but potentially fatal ingestion that requires unique evaluation and management skills. Most commonly, iron overdose occurs as a result of unintentional ingestion in pediatric patients through iron-containing vitamins or other iron supplements. There are around 11,000 annual ingestions reported in the United States in children less than six years of age which comprise around 75% of all ingestions.1,2 It is still important for providers to be aware of intentional ingestions, which occur less commonly but carry a greater mortality rate, 10% compared to the 1% of unintentional ingestions. Intentional ingestions occur more frequently in female patients with a mean age of 19.8 years.3 Patients commonly present with gastrointestinal disturbances in the first few hours after an ingestion. There is a latent phase during which the patient may become asymptomatic prior to entering a phase of shock and organ failure. It is important for providers to recognize this latent phase because patients with a history of ingestion will still require a thorough work up for iron toxicity. Depending on amount of ingestion and iron levels, patients may require chelation therapy and other supportive measures.
By the end of this oral boards case, learners will: 1) demonstrate evaluation of a patient presenting with toxic ingestion, including obtaining pertinent history, 2) review the signs and symptoms of the different presenting phases of acute iron ingestion, and 3) demonstrate appropriate treatment of iron overdose, namely, iron chelation therapy with deferoxamine.
Oral boards case.
Overdose, iron toxicity, toxicology, deferoxamine.