Oral Ingestion of an Iron-Containing Hand Warmer in a Pediatric Patient

Jeremy R. Hardin, Emi Suzuki, Justin A. Seltzer, Raymond T. Suhandynata, Mamata Sivagnanam, Daniel R. Lasoff
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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.
一名儿科患者口服含铁暖手器
暖手包是一种常见的产品,可通过铁的放热氧化作用提供便携、不易燃的热源。我们报告了首例小儿误食暖手袋的病例,一名三岁男童在误食 HOTHANDS 暖手袋后出现血清铁浓度升高(峰值 335 ug/dL)和胃肠道损伤。他接受了内窥镜胃异物取出和洗胃、质子泵抑制剂和全肠冲洗治疗。暖手包中含有还原铁粉,与铁盐相比,还原铁粉的安全性更佳。还原铁的毒性机制尚不清楚,但认为是由于在酸性环境中转化为毒性更强的铁离子所致。虽然目前的成人文献表明,摄入一包暖手宝不会有太大风险,但我们的病例表明,即使是部分摄入也会给幼儿带来铁中毒和直接胃肠道腐蚀性损伤的巨大风险。本病例表明,需要进行多学科护理,并考虑紧急内窥镜异物取出和洗胃,然后进行全肠冲洗,以减轻严重铁中毒的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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