Singhi Sunit C, Baranwal Arun Kumar, M Jayashree
Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Indian Pediatr. 2003 Dec;40(12):1177-82.
In this retrospective study, we examined the prevalence of acute iron poisoning among children attending Pediatric Emergency service of a teaching hospital, and studied their clinical profile, treatment and outcome to define intensive care needs. During the 5 years' study period of 27125 patient visits to Pediatric Emergency, 337 (1.2%) were for accidental poisoning. Of these 21(7%) patients had iron poisoning; 18 were transferred to PICU. Three patients were asymptomatic, others had vomiting (n =15, 83%), diarrhoea (n =13, 72%), malena (n = 8, 44%), and hemetemesis (n=6, 33%) generally within 6 hours of ingestion. Nine progressed to shock and/or impaired consciousness; two had acute liver failure. Dose of ingested iron and clinical signs were most useful guide to iron toxicity and management decisions; serum iron did not help. Gastric lavage yielded fragments of iron tablets in 10 patients. On desferrioxamine infusion Vin-rose colour urine was not seen in 31% even in presence of high serum iron. Shock responded to normal saline (33 +/- 15 mL/kg) and dopamine (10 +/- 4 microg/kg/min) within 4-24 hours in 7 of 9 patients. Presence of shock or acute liver failure with coagulopathy and/or severe acidosis predicted all the four deaths. Desferrioxamine infusion and supportive care of shock was the mainstay.
在这项回顾性研究中，我们调查了一家教学医院儿科急诊就诊儿童中急性铁中毒的患病率，并研究了他们的临床特征、治疗方法及预后，以确定重症监护需求。在为期5年的研究期间，儿科急诊共接待了27125名患者，其中337例（1.2%）为意外中毒。在这些患者中，21例（7%）为铁中毒；18例被转入儿科重症监护病房。3例患者无症状，其他患者一般在摄入铁剂后6小时内出现呕吐（n = 15，83%）、腹泻（n = 13，72%）、黑便（n = 8，44%）和呕血（n = 6，33%）。9例病情进展为休克和/或意识障碍；2例出现急性肝衰竭。摄入铁剂的剂量和临床症状是判断铁中毒及指导治疗决策的最有用指标；血清铁水平并无帮助。10例患者洗胃后发现有铁片碎片。在输注去铁胺时，即使血清铁水平很高，仍有31%的患者未出现葡萄酒色尿。9例休克患者中有7例在4 - 24小时内对生理盐水（33 ± 15 mL/kg）和多巴胺（10 ± 4 μg/kg/min）治疗有反应。休克、急性肝衰竭合并凝血功能障碍和/或严重酸中毒预示着全部4例死亡。输注去铁胺及对休克进行支持治疗是主要治疗方法。
