Hand warmer related corrosive injury

Tseng, Yu-Chi; Chen, C.-H.; Chen, W.-K.; Dong-Zong, H.

doi:10.3109/15563650.2011.607460

Cited by 7 publications

(11 citation statements)

References 1 publication

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“…Among reviewed case reports, 1 patient exposed to a chemical hand warmer demonstrated severe vomiting and gastritis, as evidenced by endoscopy. 2 However, multiple other case reports describe patients with similar ingestions-some resulting in serum iron concentrations of 4200 micrograms/dL, as well as visible radiopacities in abdominal radiographs-who remained entirely asymptomatic. 1 Although the composition of hand warmers differs between manufacturers, the authors noted the following ingredients were common among all products: iron powder, activated charcoal, and salt.…”

Section: Discussionmentioning

confidence: 99%

Chemical Hand Warmer Packet Ingestion: A Case of Elemental Iron Exposure

Weiland

Sherrow

Jayant

et al. 2017

Wilderness & Environmental Medicine

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For individuals who work outdoors in the winter or play winter sports, chemical hand warmers are becoming increasingly more commonplace because of their convenience and effectiveness. A 32-year-old woman with a history of chronic pain and bipolar disorder presented to the emergency department complaining of a "warm sensation" in her mouth and epigastrium after reportedly ingesting the partial contents of a chemical hand warmer packet containing between 5 and 8 g of elemental iron. She had been complaining of abdominal pain for approximately 1 month and was prescribed unknown antibiotics the previous day. The patient denied ingestion of any other product or medication other than what was prescribed. A serum iron level obtained approximately 6 hours after ingestion measured 235 micrograms/dL (reference range 40-180 micrograms/dL). As the patient demonstrated no new abdominal complaints and no evidence of systemic iron toxicity, she was discharged uneventfully after education. However, the potential for significant iron toxicity exists depending on the extent of exposure to this or similar products. Treatment for severe iron toxicity may include fluid resuscitation, whole bowel irrigation, and iron chelation therapy with deferoxamine. Physicians should become aware of the toxicity associated with ingestion of commercially available hand warmers. Consultation with a medical toxicologist is recommended.

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Section: Discussionmentioning

confidence: 99%

Chemical Hand Warmer Packet Ingestion: A Case of Elemental Iron Exposure

Weiland

Sherrow

Jayant

et al. 2017

Wilderness & Environmental Medicine

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“…Normally, Fe absorption is physiologically regulated to avoid Fe toxicity (see bellow in section 2.2.). Sporadic accidental, intentional suicidal or occupational exposure to Fe may occur, but rarely has it been linked to neurotoxicity (Andersen, 2004; Anderson, 1994; Carlsson et al, 2008; Howland, 1996; Jang and Hoffman, 2011; Magdalan et al, 2011; Siew et al, 2008; Sipahi et al, 2002; Tseng et al, 2011). Within the context of neurodegeneration, there is no longitudinal study supporting that a single episode of exposure to toxic Fe levels results in delayed neurodegeneration.…”

Section: Ironmentioning

confidence: 99%

Metals, oxidative stress and neurodegeneration: A focus on iron, manganese and mercury

Farina

Ávila

Rocha

et al. 2013

Neurochemistry International

481

266

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Essential metals are crucial for the maintenance of cell homeostasis. Among the 23 elements that have known physiological functions in humans, 12 are metals, including iron (Fe) and manganese (Mn). Nevertheless, excessive exposure to these metals may lead to pathological conditions, including neurodegeneration. Similarly, exposure to metals that do not have known biological functions, such as mercury (Hg), also present great health concerns. This reviews focuses on the neurodegenerative mechanisms and effects of Fe, Mn and Hg. Oxidative stress (OS), particularly in mitochondria, is a common feature of Fe, Mn and Hg toxicity. However, the primary molecular targets triggering OS are distinct. Free cationic iron is a potent pro-oxidant and can initiate a set of reactions that form extremely reactive products, such as OH•. Mn can oxidize dopamine (DA), generating reactive species and also affect mitochondrial function, leading to accumulation of metabolites and culminating with OS. Cationic Hg forms have strong affinity for nucleophiles, such as –SH and –SeH. Therefore, they target critical thiol- and selenol-molecules with antioxidant properties. Finally, we address the main sources of exposure to these metals, their transport mechanisms into the brain, and therapeutic modalities to mitigate their neurotoxic effects.

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“…The hand warmers consisted of iron powder (50% w/ w), sodium chloride, activated charcoal, and nontoxic vermiculite (Tam et al, 2008;Tseng et al, 2011). Salt, as a catalyst, accelerates the reaction of elemental iron oxidation, 4Fe + 3O2 + 2nH2O -salt (catalyst)-> 2Fe2O3•2nH2O + heat.…”

Section: Discussionmentioning

confidence: 99%

Water reduces iron toxicity

Chu

Yang

2022

Toxicol Ind Health

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An 86-year-old man presented to the emergency room with vomiting and melena. The patient was hemodynamically stable and remained alert and orientated. According to his family, ingestion of a pack of disposable hand warmers, which he mistook for black sesame powder, occurred 17 h prior to admission. Before ingestion, he mixed the powder with warm water. Physical examination revealed no thermal injury of the oral mucosa with no abdominal pain or tenderness. An abdominal plain film showed multiple scattered radiopaque material with zonal distribution over the right abdomen. An intravenous 500-mg deferoxamine challenge test showed no vin rosé urine discoloration. Serial serum iron levels remained within the normal range. The patient remained clinically stable with no medical complications. He was discharged 3 days after admission. The hand warmers consisted of iron powder (50% w/w), sodium chloride, activated charcoal, and nontoxic vermiculite: a potential risk for intestinal thermal injury. In this case, the water added beforehand rapidly terminated the iron oxidation reaction. This explained the lack of thermal injury. Ferric oxide is poorly absorbed by the digestive tract and explained the absence of iron intoxication. Therefore, clinicians should clarify the method of ingestion. If a hand warmer has been premixed with water, less mucosa injury can be expected with a lower risk of iron intoxication. This report also provided evidence that abdominal plain films can be used to confirm the ingestion of iron and monitor its elimination.

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Hand warmer related corrosive injury

Abstract: It appears that significant toxicity will occur after ingestion of one hand warmer packet. Appropriate gastrointestinal decontamination and aggressive management are needed for all patients who are hand warmers intoxicated.

Cited by 7 publications

References 1 publication

Chemical Hand Warmer Packet Ingestion: A Case of Elemental Iron Exposure

Chemical Hand Warmer Packet Ingestion: A Case of Elemental Iron Exposure

Metals, oxidative stress and neurodegeneration: A focus on iron, manganese and mercury

Water reduces iron toxicity

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