Ferrous sulfate toxicity - A review of autopsy findings

Ferrous sulfate is the leading cause of accidental pediatric poisonings. De spite the requirement for child-resistant packaging for any oral iron produ ct with 250 mg or more per container, the incidence has continued to increa se. Although the clinical presentation of iron toxicity has been well descr ibed, pathologic findings in human tissue and correlation with clinical dat a are scant. We reviewed autopsies from the Armed Forces Institute of Patho logy of 11 children who died from ferrous sulfate toxicity. Clinical data, morphologic changes, and iron levels in tissue were evaluated. The children 's ages ranged from 11 to 36 mo. Prominent iron deposition in gastric and s mall intestinal mucosa was associated with necrosis, with some cases demons trating prominent vascular iron deposition. The clinical courses were rapid and progressed from Stage I to Stage ill. These observations were correlat ed with increased levels of iron in various tissues, as determined by analy tical atomic absorption spectrophotometry. The morphologic and chemical ana lysis data provide information on the pathogenesis of ferrous sulfate poiso ning; the vascular iron deposition may be related to subsequent hemorrhage. Ln the liver the periportal necrosis is probably a direct cytopathic effec t of the highest levels of iron carried to these cells by the portal blood flow.