Beware of Iron

Iron poisoning used to be a relative rarity. Old-fashioned iron tonics went out of style in the U.S. long ago, and even when they were around, no child would take more than a swallow of the vile-tasting stuff. But now doctors have learned to use iron tablets in the treatment and prevention of one common form of anemia, especially in pregnant women. And to make them easy to take, the tablets are usually chocolate-or sugar-coated and are brightly colored. They look and taste so much like candy that iron poisoning of small children is becoming increasingly common. In the past 15 years there have been hundreds of cases, many of them fatal.

Last week two toddlers in Charleston, S.C., owed their prompt recoveries and probably their lives to the fact that young doctors remembered having read during the past year of a new and highly effective, but still experimental, treatment for iron poisoning. Lieut. Commander Lawrence G. Thorne, 31, was on duty at Charleston's U.S. Naval Hospital when two-year-old Michael V. Tate, son of a radarman, was brought in critically ill after swallowing from 30 to 60 of his mother's iron pills. Dr. Thorne quickly ordered blood transfusions and put the child on EDTA, a chemical that attracts many metals to itself and eases them out of the body. Michael seemed to improve rapidly.

But Dr. Thorne knew this was a deceptive reaction, likely to be followed by a worse crisis leading to convulsions, shock and possibly death. He decided to try the experimental drug he had read about, desferrioxamine-B (trade-named Desferal by Ciba Pharmaceutical Co.). The trouble was, only a few medical centers had been approved to use the stuff; Dr. Thorne phoned Ciba to learn where he could find a supply. The nearest proved to be at Duke Hospital in Durham, N.C., and it took a special flight by a Navy plane to get the Desferal to Charleston in time. With the new drug, which is safer than EDTA because it spares other metals but leaches out iron selectively, Michael Tate perked up fast and has fully recovered.

He was hardly on the way home, though, when Charleston's Medical College Hospital got an identical case. Larry Jones, also aged two, had gorged himself on mother's iron tablets and was in critical condition. Pediatrician John R. Paul Jr. decided to take the same steps as Dr. Thorne. The trick was to find more Desferal, and it turned out that Duke Hospital had had only that one dose. Another was located at Emory University Hospital in Atlanta, and this time an Air Force plane picked it up. When Larry was finally out of danger, Dr. Paul said: "I think the Desferal probably saved his life, and it certainly made a big difference in his response to treatment."

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