Acute Liver Failure Due to Iron Overdose in an Adult

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Acute Liver Failure Due to Iron Overdose in an Adult.

Southern Medical Journal. 98(2):241-244, February 2005.

Daram, Sumanth R. MD; Hayashi, H. MD

Abstract:

The vast majority of acute iron toxicity cases occur in children less than 5

years of age. Moreover, clinical hepatic injury is uncommon with most

symptoms stemming from the intestinal tract (eg, nausea, vomiting,

diarrhea). Therefore, physicians, particularly those who do not routinely

treat pediatric patients, are often unfamiliar with hepatotoxicity related

to iron overdose. Nevertheless, hepatotoxicity caused by acute iron

poisoning is associated with a high mortality rate. We report a case of

severe hepatic injury in an adult who overdosed on iron tablets with

suicidal intent. Tests for other hepatotoxins (eg, acetaminophen),

hepatatrophic viruses, and other causes of acute liver injury were negative.

Although peak serum iron level (340 [mu]g/dL) was significantly lower than

that reported to cause hepatotoxicity (>1,700 [mu]g/dL), rapid and

significant elevations in aminotransferases (>4,000 U/L), total bilirubin (5

mg/dL), and prothrombin time (50 seconds) occurred within 48 hours.

Treatment with deferoxamine was prompt and followed by empiric

N-acetylcysteine once liver injury was apparent. The patient was minimally

symptomatic and she eventually had a full recovery.

[Guest guest]

Acute Liver Failure Due to Iron Overdose in an Adult.

Southern Medical Journal. 98(2):241-244, February 2005.

Daram, Sumanth R. MD; Hayashi, H. MD

Abstract:

The vast majority of acute iron toxicity cases occur in children less than 5

years of age. Moreover, clinical hepatic injury is uncommon with most

symptoms stemming from the intestinal tract (eg, nausea, vomiting,

diarrhea). Therefore, physicians, particularly those who do not routinely

treat pediatric patients, are often unfamiliar with hepatotoxicity related

to iron overdose. Nevertheless, hepatotoxicity caused by acute iron

poisoning is associated with a high mortality rate. We report a case of

severe hepatic injury in an adult who overdosed on iron tablets with

suicidal intent. Tests for other hepatotoxins (eg, acetaminophen),

hepatatrophic viruses, and other causes of acute liver injury were negative.

Although peak serum iron level (340 [mu]g/dL) was significantly lower than

that reported to cause hepatotoxicity (>1,700 [mu]g/dL), rapid and

significant elevations in aminotransferases (>4,000 U/L), total bilirubin (5

mg/dL), and prothrombin time (50 seconds) occurred within 48 hours.

Treatment with deferoxamine was prompt and followed by empiric

N-acetylcysteine once liver injury was apparent. The patient was minimally

symptomatic and she eventually had a full recovery.