Roentgenographic Visualization of Iron Preparations in the Gastrointestinal Trace

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Abstract
Ingestion of iron-containing tablets ranks high as a cause of poisoning in children in the United States. In spite of various therapeutic regimens, the mortality rate approaches 50 per cent (1). As little as one gram may be fatal to a child (5). In children with iron intoxication vomiting, diarrhea, drowsiness, shock, and acidosis usually develop within thirty to sixty minutes after ingestion. Death follows within the first six hours in 20 per cent of the patients. In the remainder there is either gradual recovery or a period of apparent recovery lasting eight to sixteen hours, followed by shock, coma, convulsions, and death. One to two months later scarring of the stomach or bowel may cause obstruction (2). Abdominal roentgenograms have been recommended to establish the presence of iron in the gastrointestinal tract (3) and to determine the effectiveness of measures employed to remove it from the stomach and colon (3, 4). The following studies were undertaken to ascertain the roentgenographic appearance of a variety of iron tablets in vitro and in vivo. Material and Methods Fifteen commonly used iron preparations containing from 1.16 to 200 mg of elemental iron per tablet were studied (Table I). Each whole tablet was immersed in water phantoms measuring 10 and 24 cm in depth (Fig. 1). Roentgenograms were made at 36 in. with a stationary cross-hatched grid. Exposure factors were 5 mas and 60 kv for the 10 cm phantom and 50 mas and 70 kv for the 24 cm phantom. Increasing numbers of each tablet also were dissolved or suspended in test tubes containing 10 cc of water. These test tubes were then immersed in the water phantoms along with control test tubes containing only water. In a like manner, U.S.P. ferrous sulfate and ferrous fumarate were dissolved or suspended in increasing quantities to test the radiopacity of these materials without any additives or enteric coating. Seventeen mongrel dogs weighing about 30 kg were fed up to 60 tablets of 6 different iron preparations. Abdominal roentgenograms in both the supine anteroposterior and cross-table lateral projections were obtained. These films were exposed at half-hour intervals for the first two hours and then at three, four, five, six, and twenty-four hours. The dogs were not anesthetized and were in a fasting state twenty-four hours prior to and during the period of the x-ray examination. Results In vitro roentgenographic visualization of tablets was graded from 3+ (well visualized) to 0 (not visualized). All the tablets were visualized at both thicknesses of the phantom, and the majority were extremely well visualized (Table I). The only tablets poorly visualized were Simron and Simron Plus (Fig. 1; Nos. 14 and 15). The amount of elemental iron in each tablet did not correlate with its degree of radiopacity. At least 5 tablets of each compound had to be dissolved or suspended in 10 cc of water before the solutions or suspensions appeared denser than water (Fig. 2).

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