A fatal case of acute iron poisoning causing acute hepatic failure

DOI 1 Citations
  • Mizutani Atsushi
    Emergency Medical Care Center, Hamamatsu Medical Center
  • Kato Toshiya
    Emergency Medical Care Center, Hamamatsu Medical Center
  • Nakayama Teiji
    Emergency Medical Care Center, Hamamatsu Medical Center
  • Honjo Yumiko
    Department of Gastroenterology, Hamamatsu Medical Center
  • Kageyama Fujito
    Department of Gastroenterology, Hamamatsu Medical Center
  • Mori Hiroki
    Department of Pathology, Hamamatsu Medical Center
  • Ozawa Takachika
    Department of Pathology, Hamamatsu Medical Center
  • Yoshino Atsuto
    Emergency Medical Care Center, Hamamatsu Medical Center Department of Emergency & Disaster Medicine, Hamamatsu University School of Medicine

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  • 急性鉄中毒に起因する急性肝不全により死亡した一例

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We report a fatal case of severe acute iron poisoning, which is extremely rare in Japan. The patient died due to acute hepatic failure and its complications. The patient was a 23-year-old woman with anemia who was treated with ferrotherapy. She intentionally ingested an over-dose of iron of 2,400 mg. At the time of treatment initiation in our hospital, she only experienced mild drowsiness, stomachache, and vomiting. Therefore at that time, we did not identify the poisoning as severe. Subsequently, her condition progressively worsened, and she experienced disturbed consciousness, and disseminated intravascular coagulation (DIC) was observed. We treated her by intravenous infusion of deferoxamine, transfusion, plasma exchange, and continuous hemodiafiltration. However, she died of hepatic failure and its complications - DIC and brain swelling. Therefore, treatment of severe acute iron poisoning should be initiated before complete hepatic failure. Decontamination treatment and intravenous infusion of deferoxamine should be promptly administered in cases with severe acute iron poisoning. Moreover, a combined therapy involving an intravenous infusion of deferoxamine and acute hemocatharsis may be required.

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