A 4-year-old child ingested a substance found in a purse, causing vomiting and abdominal pain. Which medication is most likely involved?

A 4-year-old child ingested a substance found in a purse, causing vomiting and abdominal pain. Which medication is most likely involved?

• A. Cisplatin
• B. Erythropoietin
• C. Ferrous sulfate
• D. Lisinopril

Answer: (C)

The scenario points to an iron overdose from ferrous sulfate tablets. Iron supplements are common in households and can be carried in a purse, so a child who ingests them may develop immediate irritation of the stomach and intestines, leading to vomiting and abdominal pain. Iron is caustic to the GI tract, and when absorbed in large amounts it disrupts cellular processes, producing a progression of toxicity that can include metabolic acidosis, shock, liver injury, and coagulopathy if not treated. Understanding the time course helps: after the initial GI symptoms, there can be a brief improvement, followed by a second, more serious phase as iron continues to affect organs. Treatment depends on the amount ingested and timing; significant ingestion may require chelation therapy with deferoxamine to bind iron and help eliminate it from the body. Other drugs listed are less consistent with this scenario. Cisplatin is a chemotherapy agent with different toxicities and is not something typically found in a purse. Erythropoietin is usually given by injection for anemia and not something a child would ingest accidentally. Lisinopril, an antihypertensive, can cause hypotension but does not classically produce the acute GI-predominant poisoning pattern seen with iron tablets.

The scenario points to an iron overdose from ferrous sulfate tablets. Iron supplements are common in households and can be carried in a purse, so a child who ingests them may develop immediate irritation of the stomach and intestines, leading to vomiting and abdominal pain. Iron is caustic to the GI tract, and when absorbed in large amounts it disrupts cellular processes, producing a progression of toxicity that can include metabolic acidosis, shock, liver injury, and coagulopathy if not treated.

Understanding the time course helps: after the initial GI symptoms, there can be a brief improvement, followed by a second, more serious phase as iron continues to affect organs. Treatment depends on the amount ingested and timing; significant ingestion may require chelation therapy with deferoxamine to bind iron and help eliminate it from the body.

Other drugs listed are less consistent with this scenario. Cisplatin is a chemotherapy agent with different toxicities and is not something typically found in a purse. Erythropoietin is usually given by injection for anemia and not something a child would ingest accidentally. Lisinopril, an antihypertensive, can cause hypotension but does not classically produce the acute GI-predominant poisoning pattern seen with iron tablets.