A 23-year-old pregnancy woman is referred by her obstetrician for evaluation of anemia. She is in her fourth month of pregnancy and has no history of anemia; her grandfather had pernicious anemia. Her hemoglobin is 10 g/dL (normal, 12-16 g/dL).
If this patient has a young child at home and is taking iron-containing prenatal supplements, she should be warned that they are a common source of accidental poisoning in young children and advised to make a special effort to keep these pills out of her child's reach. Toxicity associated with acute iron poisoning usually includes (AIPG 2009)
|A||Dizziness, hypertension, and cerebral hemorrhage|
|B||Hyperthermia, delirium, and coma|
|C||Hypotension, cardiac arrhythmias, and seizures|
|D||Necrotizing gastroenteritis, shock, and metabolic acidosis|
|E||Severe hepatic injury, encephalitis, and coma|
Acute iron poisoning often causes severe gastrointestinal damage resulting from direct corrosive effects, shock from fluid loss in the gastrointestinal tract, and metabolic acidosis from cellular dysfunction.