1
|
Hardin JR, Suzuki E, Seltzer JA, Suhandynata RT, Sivagnanam M, Lasoff DR. Oral Ingestion of an Iron-Containing Hand Warmer in a Pediatric Patient. Wilderness Environ Med 2024; 35:70-73. [PMID: 38379476 DOI: 10.1177/10806032231222373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Hand warmer packets are common products used to provide a portable, nonflammable heat source via the exothermic oxidation of iron. We present the first reported case of pediatric hand warmer packet ingestion in a three-year-old male who developed an elevated serum iron concentration (peak 335 ug/dL) and gastrointestinal injury after ingesting the contents of a HOTHANDS hand warmer packet. He was treated with endoscopic gastric foreign body removal and lavage, as well as proton-pump inhibitors and whole bowel irrigation. Hand warmer packs contain reduced elemental iron powder, which has been shown to have a more favorable safety profile when compared to iron salts. The mechanism of toxicity for reduced iron is unknown, though it is thought to be due to conversion to more toxic iron ions in an acidic environment. While the current adult literature suggests that ingestion of a single hand warmer packet is without significant risk, our case demonstrates that even a partial ingestion carries a significant risk of both iron toxicity and direct gastrointestinal caustic injury in a young child. This case demonstrates the need for multidisciplinary care and consideration of urgent endoscopic foreign body removal and gastric lavage followed by whole bowel irrigation to mitigate the potential of severe iron toxicity.
Collapse
Affiliation(s)
- Jeremy R Hardin
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
| | - Emi Suzuki
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, CA
- Rady Children's Hospital, San Diego, CA
| | - Justin A Seltzer
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
| | - Raymond T Suhandynata
- Department of Pathology, UC San Diego Health, San Diego, CA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego Health, San Diego, CA
| | - Mamata Sivagnanam
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, CA
- Rady Children's Hospital, San Diego, CA
| | - Daniel R Lasoff
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
| |
Collapse
|
2
|
Wu BS, Chu FY, Yang CY. Water reduces iron toxicity. Toxicol Ind Health 2022; 38:773-775. [PMID: 36062486 DOI: 10.1177/07482337221124666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Bo-Sheng Wu
- 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.,Institute of Clinical Medicine, School of Medicine, 210821National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Yuan Chu
- 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
| | - Chih-Yu Yang
- 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.,Institute of Clinical Medicine, School of Medicine, 210821National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, 46615Taipei Veterans General Hospital, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), 210821National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Stem Cell Research Center, 210821National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
3
|
Van Buiten CB, Wu G, Lam YY, Zhao L, Raskin I. Elemental iron modifies the redox environment of the gastrointestinal tract: A novel therapeutic target and test for metabolic syndrome. Free Radic Biol Med 2021; 168:203-213. [PMID: 33831549 PMCID: PMC8544024 DOI: 10.1016/j.freeradbiomed.2021.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/25/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022]
Abstract
Metabolic syndrome (MetS, i.e., type 2 diabetes and obesity) is often associated with dysbiosis, inflammation, and leaky gut syndrome, which increase the content of oxygen and reactive oxygen species (ROS) in the gastrointestinal (GI) tract. Using near-infrared fluorescent, in situ imaging of ROS, we evaluated the effects of oral administration of elemental iron powder (Fe0) on luminal ROS in the GI tract and related these changes to glucose metabolism and the gut microbiome. C57Bl/6J mice fed low-fat or high-fat diets and gavaged with Fe0 (2.5 g per kg), in both single- and repeat-doses, demonstrated decreased levels of luminal ROS. Fourteen days of repeated Fe0 administration reduced hyperglycemia and improved glucose tolerance in the obese and hyperglycemic animals compared to the untreated obese controls and reduced the relative amount of iron oxides in the feces, which indicated an increased redox environment of the GI tract. We determined that Fe0 administration can also be used as a diagnostic assay to assess the GI microenvironment. Improved metabolic outcomes and decreased gastrointestinal ROS in Fe0-treated, high-fat diet-fed animals correlated with the increase in a co-abundance group of beneficial bacteria, including Lactobacillus, and the suppression of detrimental populations, including Oscillibacter, Peptococcus, and Intestinimonas. Daily Fe0 treatment also increased the relative abundance of amplicon sequence variants that lacked functional enzymatic antioxidant systems, which is consistent with the ability of Fe0 to scavenge ROS and oxygen in the GI, thus favoring the growth of oxygen-sensitive bacteria. These findings delineate a functional role for antioxidants in modification of the GI microenvironment and subsequent reversal of metabolic dysfunction.
Collapse
Affiliation(s)
- Charlene B Van Buiten
- Department of Food Science and Human Nutrition, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, 80525, USA; Department of Plant Biology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, 08901, USA.
| | - Guojun Wu
- Department of Biochemistry and Microbiology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, 08901, USA; Center for Microbiome, Nutrition and Health, New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ, 80901, USA
| | - Yan Y Lam
- Department of Biochemistry and Microbiology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, 08901, USA; Center for Microbiome, Nutrition and Health, New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ, 80901, USA
| | - Liping Zhao
- Department of Biochemistry and Microbiology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, 08901, USA; Center for Microbiome, Nutrition and Health, New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ, 80901, USA
| | - Ilya Raskin
- Department of Plant Biology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, 08901, USA
| |
Collapse
|
4
|
|
5
|
Gotanda H, Kameyama Y, Yamaguchi Y, Ishii M, Hanaoka Y, Yamamoto H, Ogawa S, Iijima K, Akishita M, Ouchi Y. Acute exogenous lipoid pneumonia caused by accidental kerosene ingestion in an elderly patient with dementia: A case report. Geriatr Gerontol Int 2013; 13:222-5. [DOI: 10.1111/j.1447-0594.2012.00896.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Brutlag AG, Flint CTC, Puschner B. Iron intoxication in a dog consequent to the ingestion of oxygen absorber sachets in pet treat packaging. J Med Toxicol 2011; 8:76-9. [PMID: 22190175 DOI: 10.1007/s13181-011-0201-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Oxygen absorbers are commonly used in packages of dried or dehydrated foods (e.g., beef jerky, dried fruit) to prolong shelf life and protect food from discoloration and decomposition. They usually contain reduced iron as the active ingredient although this is rarely stated on the external packaging. Although reduced iron typically has minimal oral bioavailability, such products are potential sources of iron poisoning in companion animals and children. We present a case of canine ingestion of an oxygen absorber from a bag of dog treats that resulted in iron intoxication necessitating chelation therapy. A 7-month-old female Jack Russell terrier presented for evaluation of vomiting and melena 8-12 h after ingesting 1-2 oxygen absorber sachets from a package of dog treats. Serum iron concentration and ALT were elevated. The dog was treated with deferoxamine and supportive care. Clinical signs resolved 14 h following treatment, but the ALT remained elevated at the 3-month recheck. The ingestion of reduced iron in humans has been reported to cause mild elevation of serum iron concentration with minimal clinical effects. To our knowledge, no cases of iron intoxication following the ingestion of oxygen absorbers have been reported. The lack of ingredient information on the packaging prompted analysis of contents of oxygen absorber sachets. Results indicate the contents contained 50-70% total iron. This case demonstrates that iron intoxication can occur following the ingestion of such products. Human and veterinary medical personnel need to be aware of this effect and monitor serum iron concentrations as chelation may be necessary.
Collapse
Affiliation(s)
- A G Brutlag
- Pet Poison Helpline and SafetyCall International, PLLC, Minneapolis, MN, USA.
| | | | | |
Collapse
|
7
|
Abstract
INTRODUCTION Corrosive injury of the esophagus and stomach is never been reported after intoxication of hand warmers. Herein we reported a case that had grade IIA corrosive injury found by endoscopic examination. CASE REPORT An 84 year-old woman with a history of dementia ingested the contents of hand warmers. She had radiopaque patches in the stomach and duodenum. Upper endooscopic examination revealed corrosive injury of the esophagus and stomach. She recovered with the use of deferoxamine and proton pump inhibitor (PPI). DISCUSSION The hand warmer contains activated charcoal, salt, and vermiculite, and 50% of iron powder. In previous literature, ingestions of one hand warmer packet or less are considered less toxic. But in our case, corrosive injury of the esophagus and stomach is obvious. CONCLUSION It appears that significant toxicity will occur after ingestion of one hand warmer packet. Appropriate gastrointestinal decontamination and aggressive management are needed for all patients who are hand warmers intoxicated.
Collapse
Affiliation(s)
- Y-J Tseng
- China Medical University Hospital, Department of Emergency Medicine, No.2 Yuh Der Road, Taichung, 40402 Taiwan
| | | | | | | |
Collapse
|
8
|
What toxicity may result from the xenobiotic responsible for the finding on this plain film? Answer: reduced iron, found in heating pads and instant hand warmers, may result in elevated serum iron concentrations and subsequent iron toxicity. J Med Toxicol 2011; 7:327-8. [PMID: 21818692 DOI: 10.1007/s13181-011-0169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Disposable heating pads are commonly used products, with reduced iron as their active ingredient. Reduced iron is not expected to cause significant toxicity when ingested orally. We report a case of accidental heating pad ingestion seen on abdominal plain films that resulted in significantly elevated serum iron concentrations.
Collapse
|