Pediatric liver transplantation for fulminant hepatic failure secondary to intentional iron overdose

Lai, Joanne; Chu, Jaime; Arnon, Ronen

doi:10.1111/petr.12994

Cited by 10 publications

(10 citation statements)

References 18 publications

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“…Liver failure was reported in an adult patient with a peak serum iron level of 340 μg/dL. 6 This was seen in our case. The serum iron levels can be unreliable in the late presentation of the patient since the iron is re-distributed intra-cellularly.…”

Section: Discussionsupporting

confidence: 67%

Non-suicidal intentional ingestion of iron tablets and severe intoxication: the result of adolescent boy’s impulsive risky behaviour in the school

Tandon

Khandwala

et al. 2021

Int J Contemp Pediatr

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Acute iron poisoning is a potentially fatal intoxication in children. As the Iron preparations are commonly administered to pregnant women, lactating mothers, toddlers, it is easily available at home. So younger children are prone to consume it accidently. Although iron is a therapeutic drug in recommended dosages, excessive iron in the free state can produce toxicity by affecting multiple cellular processes by catalysing redox reactions with lipid peroxidation and free radical formation. The severity of intoxication depends on the amount of elemental iron ingested. Serious toxicity is usually associated with a dose of >40 mg/kg of elemental iron. Levels more than 100 mg/kg are almost always fatal. We report a case where a 12-year male child intentionally taken 60 tablets of iron (ferrous fumarate) at his school as a part of competition or bet to other schoolmate and presented with acute iron poisoning with hepatic encephalopathy to us. Important initial laboratory parameters were AST-4,879 U/L, Prothrombin time-60 sec and Iron level-213 microgram/dl. With timely specific management i.e., deferoxamine infusion along with all required intensive care supportive management in PICU the patient was discharged successfully. We chose to report this case to highlight the risky behaviour of adolescence who usually grows physically and emotionally earlier but their prefrontal lobes are yet immature to take proper and correct decision. Thus, impulse activity may prove fatal for them.

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Section: Discussionsupporting

confidence: 67%

Non-suicidal intentional ingestion of iron tablets and severe intoxication: the result of adolescent boy’s impulsive risky behaviour in the school

Tandon

Khandwala

et al. 2021

Int J Contemp Pediatr

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“…Liver transplantation is an option in patients with acute liver failure resulting from iron overdose but with unpredictable outcomes. Liver transplant was successful in two adolescent patients with large intentional iron overdose who developed rapidly progressive fulminant hepatic failure despite deferoxamine therapy [9]. In another two cases with co‐ingestion of iron and acetaminophen, patients died even after liver transplant [4].…”

Section: Discussionmentioning

confidence: 99%

Suicidal iron overdose: A case report and review of literature

Giffen

2021

Journal of Forensic Sciences

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Acute iron toxicity in adults is rare, usually occurring due to intentional ingestion in suicide attempts. Few cases of the clinical and autopsy findings in acute iron toxicity have previously been reported in the literature. Ingestion of large amounts of iron salts can lead to hemorrhagic shock, multi-system organ failure, coagulopathy, and death. We present the case of a 25-year-old man who reportedly ingested a large quantity of iron tablets along with ethanol in a suicide attempt and subsequently died approximately 65.5 h later. His clinical course and laboratory findings demonstrated hepatic and renal compromise with markedly elevated serum iron levels. At autopsy, iron encrustations were present over the gastric rugae. Superficial deposits of stainable iron were present overlying areas of mucosal necrosis with underlying submucosal fibrin thrombi. No significant stainable iron was present in the liver. Literature review revealed that the clinical course and laboratory testing of severe acute iron overdose is fairly non-specific. The length and type of treatment may alter the clinical course and laboratory results. Peak serum iron levels may be helpful in differentiating acute toxicity from chronic iron overload states. Gross findings of gastric iron encrustation are specific for acute ingestion when present.

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“…Iron poisoning is a risk after iron ingestion. (1–3) However, it is unknown how rapidly the absorption occurs when an iron‐containing foreign body is retained in the gastrointestinal tract. Our case evidences a rapid increase in iron levels by 1.7‐fold in 3 hours, suggesting that the potential for iron poisoning does exist with the ingestion of hematite rocks (Figs.…”

Section: Figurementioning

confidence: 99%

Hematite Ingestion in Pediatrics: Risk of Iron Poisoning

Klepper

Oliveira

2020

Journal of Pediatric Gastroenterology &Amp; Nutrition

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A 5-year-old healthy boy had a witnessed ingestion of hematite (iron oxide rock) at school. He had self-limited gagging and blood-tinged secretions. An X-ray showed a radiopaque foreign body measuring 3.5 cm by 2.2 cm in the right upper quadrant. Due to concern for iron toxicity, (1) an iron level was obtained about 3 hours after the ingestion and was 56 mg/dL, increasing to 97 mg/dL after 3 hours. The child remained asymptomatic but because of increasing iron levels with presumed risk for toxicity, the decision was made to proceed with endoscopy for removal. It was uncertain how rapidly iron could reach toxic levels as no similar cases were found in the literature. The hematite rock was successfully removed endoscopically with a Roth Net from the gastric fundus. No injuries to the stomach or esophagus were identified. Iron poisoning is a risk after iron ingestion. (1-3) However, it is unknown how rapidly the absorption occurs when an iron-containing foreign body is retained in the gastrointestinal tract. Our case evidences a rapid increase in iron levels by 1.7-fold in 3 hours, suggesting that the potential for iron poisoning does exist with the ingestion of hematite rocks (Figs. 1 and 2).

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Pediatric liver transplantation for fulminant hepatic failure secondary to intentional iron overdose

Cited by 10 publications

References 18 publications

Non-suicidal intentional ingestion of iron tablets and severe intoxication: the result of adolescent boy’s impulsive risky behaviour in the school

Non-suicidal intentional ingestion of iron tablets and severe intoxication: the result of adolescent boy’s impulsive risky behaviour in the school

Suicidal iron overdose: A case report and review of literature

Hematite Ingestion in Pediatrics: Risk of Iron Poisoning

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