Toxicological Unit, T Marciniak Hospital, Wroclaw, Poland.
Hum Exp Toxicol. 2011 Aug;30(8):1106-11. doi: 10.1177/0960327110386392. Epub 2010 Oct 15.
A 17-year-old, previously healthy female ingested 16,000 mg iron sulphate (96.15 mg of iron ions per kg of b.wt.) with a suicidal intent. The patient was admitted to a toxicology unit 10 hours after the drug ingestion. Serum iron concentration at admission was 2351 μg% (421.0 μmol/L). In the course of the intoxication, hemorrhagic gastritis, renal insufficiency and increasing signs of fulminant hepatic failure complicated with coagulopathy and encephalopathy were observed. Treatment with deferoxamine was started immediately after admission to the hospital and continued for 15 hours until the serum concentration of iron decreased to 145 μg% (25.9 μmol/L). Patient was qualified for liver transplant, therefore albumin dialysis as a bridge to liver transplantation was performed. In spite of two procedures of albumin dialysis using the Prometheus system, deep coma, shock and respiratory insufficiency developed. The patient died 80 hours after iron ingestion. In the presented case, the ingestion of a very high dose of iron and late introduction of deferoxamine treatment contributed to fulminant liver failure and fatal outcome of the intoxication.
一名 17 岁、既往健康的女性出于自杀意图摄入了 16000 毫克硫酸亚铁（每公斤体重 96.15 毫克铁离子）。患者在服药后 10 小时被收入毒理学病房。入院时血清铁浓度为 2351μg%（421.0 μmol/L）。在中毒过程中，观察到出血性胃炎、肾功能不全和暴发性肝衰竭的迹象加重，伴有凝血障碍和脑病。入院后立即开始使用去铁胺治疗，并持续 15 小时，直到血清铁浓度降至 145μg%（25.9 μmol/L）。患者符合肝移植条件，因此进行白蛋白透析作为肝移植的桥梁。尽管使用 Prometheus 系统进行了两次白蛋白透析，但仍出现深度昏迷、休克和呼吸功能不全。患者在摄入铁后 80 小时死亡。在本病例中，摄入极高剂量的铁和延迟使用去铁胺治疗导致暴发性肝衰竭和中毒的致命结局。
