Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, 46615Taipei Veterans General Hospital, Taipei, Taiwan.
Faculty of Medicine, School of Medicine, 210821National Yang Ming Chiao Tung University, Taipei, Taiwan.
Toxicol Ind Health. 2022 Nov;38(11):773-775. doi: 10.1177/07482337221124666. Epub 2022 Sep 5.
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.
一位 86 岁男性因呕吐和黑便到急诊就诊。患者血流动力学稳定，意识清醒，定向力正常。据其家属描述，患者在入院前 17 小时摄入了一包一次性暖手器，他将其误认为是黑芝麻粉。摄入前，他将粉末与温水混合。体格检查未发现口腔黏膜有热损伤，无腹痛或压痛。腹部平片显示右腹部有多个散在的不透射线物质，呈区域性分布。静脉注射 500 毫克去铁胺激发试验显示尿液无桃红变色。连续的血清铁水平仍在正常范围内。患者临床情况稳定，无医疗并发症。他在入院后 3 天出院。暖手器的成分包括铁粉（50%重量/重量）、氯化钠、活性炭和无毒蛭石：这可能导致肠道热损伤。在这种情况下，事先添加的水迅速终止了铁的氧化反应。这解释了没有热损伤的原因。氧化铁在消化道内不易被吸收，这也解释了为什么没有铁中毒。因此，临床医生应明确摄入的方法。如果暖手器事先与水混合，预计黏膜损伤会更少，铁中毒的风险也会更低。本报告还提供了证据表明，腹部平片可用于确认铁的摄入并监测其排出。
