Prenatal vitamins contain essential nutrients, one of which is iron. When iron is consumed in large quantities, it can have serious side effects. Prenatal vitamins are prescribed to women to help improve their nutritional status before pregnancy, during pregnancy and following pregnancy. The ingestion of too many prenatal vitamins could occur in people of any age group, but it is most lethal to children.
Toxicity Effects
A primary concern of prenatal vitamin overdose is the corrosive effect that iron has on the gastrointestinal lining, causing significant bleeding that can lead to hemorrhagic shock. When the lining of the intestinal tract is damaged, it allows for increased absorption of more iron. The end result of toxic levels will depend on the amount ingested and how quickly medical care is initiated.
Dosages and Time Frames
In children, mild toxicity can occur with ingestion of 20 to 40 mg/kg of iron, and severe toxicity may occur with an ingestion of greater than 60 mg/kg, according to "Core Curriculum for Pediatric Emergency Nursing." Symptoms of toxicity can occur in phases and begin as early as 30 minutes after ingestion. In the first 30 minutes to two hours, symptoms may include nausea, vomiting, stomach pain and diarrhea. The diarrhea may be bloody. Two to 12 hours following the ingestion, symptoms may appear to improve; however, significant toxicity is actually taking place during this time. Twelve to 48 hours after the initial ingestion, serious outcomes may occur, including a decreased level of consciousness, coma and shock. If this phase of toxicity is survived, a full recovery is possible, but late complications -- including necrosis of the intestinal tract -- can cause death in a matter of days to weeks later.
Treatment
Treatment of a prenatal vitamin overdose may include pumping of the stomach with a tube to remove pill fragments and administering an antidote for iron poisoning. The antidote for iron is deferoxamine, which is administered intravenously. Depending on the severity of the overdose, support of the airway and a mechanical ventilator may be necessary to aid the patient's breathing.
Considerations
In the event of a prenatal vitamin overdose, contact your local poison control center and seek medical treatment. Have the vitamin bottle available, which will provide information regarding the vitamin content and potentially the amount ingested. Do not be fooled by the improvement phase seen in the patient, as this phase can rapidly deteriorate. Seek medical care, even if you do not know how many pills were ingested.
References
- "Core Curriculum for Pediatric Emergency Nursing"; Donna Thomas, Lisa Marie Bernardo; Emergency Nurses Association; 2009
- "Emergency Nursing Pediatric Course"; Harriet Hawkins, Beth Bolick, Nancy Denke, et al.; Emergency Nurses Association; 2004
- "Davis's Drug Guide for Nurses"; Judith Deglin, April Vallerand, Cynthia Sanoski, F.A. Davis; 2009
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