Unintentional paediatric iron poisoning: A retrospective case series.

Abstract

OBJECTIVE\nIron poisoning is a historically important cause of paediatric morbidity and mortality. In recent decades, public health measures have considerably reduced paediatric iron exposures. We investigated unintentional paediatric iron poisoning in children with the aim of developing an assessment approach specific for this group.\n\n\nMETHODS\nThis was a retrospective observational study of unintentional iron poisoning in children (<7\u2009years old) referred to either a state-wide poisons information service or a tertiary clinical toxicology unit from 1 January 2015 to 16 February 2020. Patients were identified from prospective databases maintained by both services, and data were extracted from these in addition to the medical record.\n\n\nRESULTS\nThere were 54 children included in the study (29 [54%] male; median age 2\u2009years (range 8\xa0months to 4\u2009years). The median suspected dose of elemental iron ingested was 72\u2009mg/kg (IQR 41-140\u2009mg/kg). Seventeen (31%) children were symptomatic. There were no cases of severe toxicity. Children symptomatic with gastrointestinal toxicity had a median suspected dose ingested of 60\u2009mg/kg (IQR 38-150\u2009mg/kg) that was similar to asymptomatic children (81\u2009mg/kg [IQR 41-143\u2009mg/kg], P\xa0=\u20090.809). The median peak iron concentration was 49\u2009μmol/L (IQR 13.5-67.5\xa0μmol/L, range 4-75\u2009μmol/L). Symptomatic children had a significantly higher median peak serum iron concentration of 66\u2009μmol/L (IQR 54-68\u2009μmol/L) compared to 12\u2009μmol/L (IQR 9-15\u2009μmol/L) in asymptomatic children (P\xa0<\u20090.001).\n\n\nCONCLUSION\nUnintentional paediatric iron poisoning is uncommon and largely benign. Suspected dose ingested is a poor predictor of toxicity. Targeting investigations and interventions to symptomatic children should reduce unnecessary assessment and management while still safely managing the exposure.