Fatal overdose of iron tablets in adults
A 17-year-old lady allegedly consumed 300 tablets of ferrous sulfate amounting to a total dose of 20 g of elemental iron (400 mg/kg). She was initially taken to a local hospital with abdominal pain and vomiting and gastric lavage given. Further treatment details are unknown. After 48 h, she developed multiple episodes of hematemesis and melena and progressively became oliguric and drowsy. She was intubated and referred to our hospital 48 h after ingestion. At presentation, pulse and blood pressure were not recordable and resuscitated with colloids. CBC profile showed hemoglobin-2.8 g/dl, total WBC count-4,500/cu mm, platelet count-52,000/cu mm. LFT showed marked elevation in liver enzymes (SGOT-4,250 U/L and SGPT-3,908 U/L), total bilirubin (0.7 mg%), direct bilirubin (0.5 mg%), protein (2.2 g%), albumin (0.7 g%) and alkaline phosphatase (72 U/L). Serum iron levels were not measured as the patient presented more than 48 hours after ingestion. Serum creatinine was 2.4 mg%, bicarbonate was 10 mmol/l, blood sugar level was 27 mg/dl, aPTT was >3 min and PT was >2 min with an INR of >10. Aggressive supportive management along with desferrioxamine as a 15 mg/kg/h infusion was initiated. Hemodialysis was planned, but could not be instituted as the patient had refractory hypotension and had a cardiac arrest within 2 hours of presentation. Despite ventilator and inotropic supports, she continued to deteriorate with circulatory collapse and could not be resuscitated. She died within 3 h of presentation to our hospital.