Iron overdose epidemiology, clinical features and iron concentration-effect relationships: the UK experience 2008–2017

Bateman, D. N.; Victoria, Eagling; Sandilands, Euan A; Jackson, G; Crawford, Catherine; Hawkins, Leonard; Cheung, Ted; Cooper, Gail; Bradberry, Sally; Thompson, John Paul; Thomas, Simon H.L.; Eddleston, Michael

doi:10.1080/15563650.2018.1455978

Cited by 18 publications

(15 citation statements)

References 15 publications

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“…On the other hand, their increased supply may cause adverse health effects, like damage to internal organs, endocrine disruption and poor reproductive capacity and genotoxicity linked to cancers. They may also be involved in the pathogenesis of neurodegenerative diseases (25, 26, 27, 28). Moreover, it should be noted that lead accumulates in the human body, causing distant effects (29).…”

Section: Discussionmentioning

confidence: 99%

Concentrations of selected metals (NA, K, CA, MG, FE, CU, ZN, AL, NI, PB, CD) in coffee

Adler

Nędzarek

Tórz

2019

Slovenian Journal of Public Health

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Introduction The health benefits and detrimental effects of coffee consumption may be linked to chemical compounds contained in coffee beans. The aim of our study was to evaluate the concentration of sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), iron (Fe), copper (Cu), zinc (Zn), aluminum (Al), nickel (Ni), lead (Pb) and cadmium (Cd) in green and roasted samples of coffee beans purchased in Bosnia and Herzegovina, and to determine the potential health implications at current consumption level. Methods The concentrations were determined using a microwave high-pressure mineralization and atomic absorption spectrometer that measures total metal (ionic and non-ionic) content. Results The average metal concentrations (μg element/g coffee) in the green coffee beans were; Na: 18.6, K: 19898, Ca: 789, Mg: 1758, Fe: 60, Cu: 14, Zn: 3.6, Al: 4.2, Ni: 0.415, Pb: 0.076, and Cd: 0.015, while, in the roasted; Na: 23, K: 23817, Ca: 869, Mg: 1992, Fe: 41.1, Cu: 11.4, Zn: 5.41, Al: 4.19, Ni: 0.88, Pb: 0.0169, and Cd: 0.0140. Conclusion The level of investigated metals at the present level of consumption of coffee in Bosnia falls within the limits recommended as safe for health.

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Section: Discussionmentioning

confidence: 99%

Concentrations of selected metals (NA, K, CA, MG, FE, CU, ZN, AL, NI, PB, CD) in coffee

Adler

Nędzarek

Tórz

2019

Slovenian Journal of Public Health

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“…We believe deferoxamine administration is an appropriate marker of disease severity because it is the treatment of choice for severe iron toxicity. 1,11,12 Deferoxamine is indicated for iron intoxication with markedly elevated serum iron concentrations (≥500 µg/dL) and/or when significant clinical effects of iron poisoning are present, including metabolic acidosis, hypotension, and liver injury. Features of serious iron poisoning can be present within a few hours (hypotension, acidosis) or may be delayed up to 3 days (liver injury) after the overdose.…”

Section: Discussionmentioning

confidence: 99%

Iron Packaging Regulations in the United States and Pediatric Morbidity: A Retrospective Cohort Study

Leonard

Hines

2020

Clin Pediatr (Phila)

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Iron poisoning was a leading cause of pediatric morbidity and mortality. We sought to assess whether the removal of strict iron packaging requirements in 2003 resulted in an increase in iron-related morbidity and mortality in pediatric exposures. We performed a retrospective cohort study utilizing the National Poison Data System from 2000 to 2017. A total of 4110 exposures met inclusion criteria: 847 from before (2000-2003) and 3263 after removal of unit-dose package regulations (2004-2017). The incidence of any marker of severity (7.2% vs 3.8%; odds ratio = 0.51, 95% confidence interval = 0.37-0.69) and frequency of deferoxamine use were both higher in the early time period (2.6% vs 1.0%; odds ratio = 0.38, 95% confidence interval = 0.22-0.66). There was no difference in the frequency of key serious effects (acidosis, elevated transaminases, hypotension). Despite removal of iron packaging regulations in the United States, there continues to be a decrease in the incidence of severe iron exposures in children.

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“…In addition to gastrointestinal decontamination and supportive care, deferoxamine is typically administered when poisoning is severe. While the indications for deferoxamine are not established based on randomized controlled human trials, experts often use an iron concentration above 500 mcg/dL (89.5 micromol/L) as one criterion for therapy [1,[3][4][5]. We present an uncommon case of intravenous iron overdose to illustrate one limitation of the assessment of iron concentrations in the setting of overdose.…”

Section: Introductionmentioning

confidence: 99%

“…Iron overdose produces a well recognized constellation of signs and symptoms that include; nausea, vomiting, diarrhea, anion gap metabolic acidosis, hypotension, and in its most severe form fulminant hepatic failure and death [1,2]. In addition to gastrointestinal decontamination and supportive care, deferoxamine is typically administered when poisoning is severe.…”

Section: Introductionmentioning

confidence: 99%

Intravenous iron overdose: treat the patient not the number

Biary

Hoffman

2019

Toxicology Communications

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Iron overdose in its severest form is associated with fulminant hepatic failure and death. Indications for deferoxamine include a serum iron concentration greater than 500 mcg/dL. We present a case of an intravenous iron overdose to demonstrate the limitations of focusing solely on serum concentrations. A 50-year-old woman received a five-fold overdose of intravenous iron sucrose due to a medication error. Her only complaints were mild dizziness and abdominal pain. Her iron concentration 1 h after the iron infusion was 1301 mcg/dL. Due to the lack of vomiting, normal vital signs, and a normal anion gap, the treating team withheld deferoxamine and observed the patient. Her symptoms resolved spontaneously, her laboratory studies remained normal and deferoxamine was never administered. Iron sucrose is a large molecular weight compound (30,000-100,000 Daltons) designed to release iron slowly. We suspect the elevated iron concentration included iron that was complexed to carbohydrate and therefore not toxic. Clinicians need to know that intravenous iron complexed to carbohydrates may lead to serum concentrations that do not correlate with the degree of toxicity expected following iron salt ingestion. The decision to initiate chelation should depend on the patient's clinical and laboratory findings.

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Iron overdose epidemiology, clinical features and iron concentration-effect relationships: the UK experience 2008–2017

Cited by 18 publications

References 15 publications

Concentrations of selected metals (NA, K, CA, MG, FE, CU, ZN, AL, NI, PB, CD) in coffee

Concentrations of selected metals (NA, K, CA, MG, FE, CU, ZN, AL, NI, PB, CD) in coffee

Iron Packaging Regulations in the United States and Pediatric Morbidity: A Retrospective Cohort Study

Intravenous iron overdose: treat the patient not the number

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