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故意过量服用铁剂后发生暴发性肝衰竭——病例报告

Fulminant Hepatic Failure Following Intentional Iron Overdose-A Case Report.

作者信息

Putta Nagarajan Hrithik Dakssesh, Ramamoorthy Ram Vivek, Vishwanath Naveen, Murugan Miruthula, Kamaraj Balakrishnan, Balamurugan Shiva Jeyaprakash Narayan, Kumar Shubham, Gaidhane Shilpa, Sah Sanjit, Satapathy Prakasini, Mehta Rachana, Verma Amogh

机构信息

Madurai Medical College Madurai Tamil Nadu India.

Madha Medical College and Research Institute Chennai Tamil Nadu India.

出版信息

Clin Case Rep. 2025 Apr 30;13(5):e70476. doi: 10.1002/ccr3.70476. eCollection 2025 May.

Abstract

Intentional iron overdose in adults is a rare but formidable clinical challenge, often complicated by delayed presentation and a concealed history of ingestion. We report the case of a 21-year-old male who presented 4 days after consuming large quantities of ferrous sulfate tablets. The initial nonspecific gastrointestinal symptoms progressed to severe jaundice, encephalopathy, and coagulopathy, and the diagnosis was confounded by the patient's denial of suicidal ingestion. By the time iron toxicity was identified, the therapeutic window for early decontamination or parenteral chelation had been passed. Supportive care, including advanced extracorporeal therapies, facilitated hepatic and renal recovery. This case highlights the importance of high clinical suspicion, thorough history taking, and the potential role of salvage therapies in severe late-presenting iron poisoning.

摘要

成人故意过量服用铁剂是一种罕见但严峻的临床挑战,常因就诊延迟和隐匿的服药史而复杂化。我们报告一例21岁男性病例,其在大量服用硫酸亚铁片4天后就诊。最初的非特异性胃肠道症状进展为严重黄疸、脑病和凝血功能障碍,且患者否认自杀性服药使诊断变得复杂。当铁中毒被确诊时,早期去污或胃肠外螯合治疗的治疗窗口已过。包括先进体外治疗在内的支持性治疗促进了肝脏和肾脏的恢复。该病例强调了高度临床怀疑、全面病史采集的重要性,以及挽救疗法在严重迟发性铁中毒中的潜在作用。

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