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With increasing health awareness, many parents give children dietary supplements. Getting children to take tablets is difficult therefore manufacturers have produced supplements in “novelty” shapes, for example cartoon characters.
In our emergency department there have been two cases to date of children presenting with accidental overdoses of vitamin and iron supplements. The toddlers, aged 2 and 3, had taken 20 and 15 tablets respectively. The children had thought that the supplements were sweets and indulged themselves. Both were admitted and blood serum iron concentrations taken. Fortunately, neither child needed further treatment, both making an uneventful recovery.
Severity of iron ingestion depends on the total elemental iron taken. Preparations are available incorporating iron in a number of different compounds. Ferrous sulphate contains 20% elemental iron, ferrous fumarate 33%, and ferrous gluconate 12%. To calculate the total elemental iron ingested, the iron compound involved and the number of tablets taken must be known.1
Elemental iron ingestion above 20 mg/kg is likely to produce features of toxicity, above 60 mg/kg possible fatality. Preparations for children are available with elemental iron content of 6 and 12 mg. For a typical 3 year old therefore, ingestion of less than 25 tablets may result in toxicity requiring treatment; 70 tablets potential fatality.
From 12 March 1998 to 31 December 2001, there were 90 product accesses to combined iron and multivitamin tablets on Toxbase, 12 of which were from Northern Ireland (Scottish Poisons Information Bureau, The Royal Infirmary, Edinburgh, personal correspondence April, 2002; NHS National Poisons Information Service, Edinburgh Centre, Personal correspondence Feb, 2002).
Products of this type are licensed as food supplements, not as a medicine, as they do not purport any medicinal claim. The quality of the product is governed by the Food Standards Agency. Children are legally permitted to purchase the product.
Carefully worded packaging and increased consumer awareness is necessary to prevent a fatality.
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