title: Acute iron poisoning: management guidelines.
abstract: Serum iron level may not be available and fully reliable in management decision and prognostication in our setting. An estimated ingestion of >60 mg/kg elemental iron, onset of symptoms, blood sugar >150 mg/dL, total leukocyte count >15,000 cumm and presence of iron tablets on abdominal radiograph indicates severe toxicity and need for chelation therapy. Appearance of "vin-rose" color urine following a dose of desferrioxamine may be helpful, but is not seen consistently after chelation therapy. Early decontamination of gut (gastric lavage/whole gut irrigation), desferrioxamine infusion (15 mg/kg/hour in saline), and aggressive management of shock, and organ failure preferably in a PICU are mainstay of management, and has improved the outcome. Shock, coagulopathy (prothrombin index <50%), severe acidosis and acute liver failure are poor prognostic indicators. Guardians should be counseled about safe storage of iron tablets made for adults, and general poisoning prevention measures.
authors.affiliation: Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Arun K
authors.initials: AK
authors.lastname: Baranwal
authors.forename: Sunit C
authors.initials: SC
authors.lastname: Singhi
mesh_terms: D002648:Child; D002675:Child, Preschool; D005751:Gastric Lavage; D006801:Humans; D007501:Iron / Q000506:poisoning*; D007502:Iron Chelating Agents / Q000627:therapeutic use; D008020:Life Support Care; D011041:Poisoning / Q000628:therapy
chemical_list: D007502:Iron Chelating Agents; D007501:Iron