Pediatric: Practice Question

Acute iron toxicity most frequently presents with which of the following in the pediatric population?
  1. Vomiting and diarrhea
  2. Metabolic abnormalities including metabolic acidosis, coagulopathy and hypotension
  3. Confusion, possibly stupor and coma
  4. Hepatic dysfunction
  5. Thyroid dysfunction
Show Answer and Explanations

Vomiting and diarrhea — Correct answer

Correct. Vomiting and diarrhea, particularly hemorrhagic gastroenteritis, is the most common presentation of acute iron toxicity in children.

Metabolic abnormalities including metabolic acidosis, coagulopathy and hypotension

Incorrect. This occurs after the gastrointestinal symptoms.

Confusion, possibly stupor and coma

Incorrect. Encephalitis occurs after the metabolic abnormalities.

Hepatic dysfunction

Incorrect. Hepatic dysfunction occurs after the encephalopathy.

Thyroid dysfunction

Incorrect. Thyroid dysfunction is usually not seen.

Summary

Summary: Iron toxicity progresses from vomiting and diarrhea from gastroenteritis, to metabolic abnormalities, to encephalitis (the most common time of death), to hepatic dysfunction, and after resolution there may be scarring and obstruction of the gastrointestinal tract.
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