Iron overdose in a fifteen-month-old child.

Abstract

A fter calling the poison control center, a mother brought her 15month-old son to the emergency department. She had found him with an older brother, playing the game of “I’ll eat one if you’ll eat one” with her iron tablets. The older brother, however, had not eaten his share, ingesting only one or two tablets. The child was alert and active. There were no signs of shock. There had been no spontaneous emesis or diarrhea. He was given 15 ml of syrup of ipecac orally 5 minutes after his arrival. Fifteen minutes later he vomited some pill fragments. A kidneyureters-bladder (KUB) x-ray film was taken, and it clearly showed approximately 24 tablets remaining in the stomach and one in the lower abdomen (Fig. 1). The empty bottle indicated that the enteric-coated tablets contained 300 mg of ferrous sulfate. There is 60 mg of elemental iron in each 300 mg tablet of ferrous sulfate. Twenty-five tablets times 60 mg of iron would equal a total ingestion of 1500 mg of elemental iron. Since the child weighed 11.3 kg, the ingestion was 133 mg/kg (toxic level, 60 mgjkg). An IV line was started with 0.2% sodium chloride in 5% dextrose in water. A size 32 French nasogastric tube was passed into the stomach by the oral route. Lavage was performed with 5% sodium bicarbonate in normal saline solution. After vigorous lavage, only a small number of tablet fragments had been obtained. Repeat x-ray films revealed apparently the same quantity of tablets in the stomach, but there was one additional tablet in the ascending colon. Consultation with the regional poison center was obtained. The recommendation was immediate gastrotomy for removal of the tablets.