To do or not to do, to take or not to take medicine, to take a test or not to take a test. We are always faced with a choice and are often afraid of making a mistake. Iron can be said that you can’t go wrong with iron.
The adult human body contains about 3–4.5 g of iron. More than half of the iron is represented by heme in the composition of hemoglobin, a third is stored in the depot in the form of ferritin and hemosiderin. Moreover, iron deficiency is the most common deficiency condition worldwide, silently leading to anemia.
Iron poisoning
· Iron Fe from lat.
Ferrum is the eighth element of the periodic table, with high chemical reactivity. · Poisoning occurs due to the ingestion of iron preparations in toxic (symptomatic) doses.
· The condition can be potentially fatal in high concentrations, especially in children.
· Early diagnosis of intoxication is essential to ensure proper treatment and prevent death.
· Poisoning is common in children under 5 years of age due to accidental overdose, usually due to irresponsible storage of medications.
· Most poisonings are unintentional and cause no acute symptoms or minimal toxicity.
· A dose of 20-60 mg/kg causes signs of moderate poisoning in an adult. Consumption of 30 mg/kg body weight is considered toxic to the body. The lethal dose is significantly higher and is more than 100 mg. In children, this threshold is several times lower.
Why does stool turn green?
Drinking fruit juices may change the color of your stool.
Green stool can occur in both adults and children. The main reason for this is poor nutrition.
Typically, the color of fecal matter changes due to the consumption of large amounts of food products that contain iron and artificial colors. Eg:
- Black licorice
- Fruit juices
- Cereals, thoughts
- Sea fish, red meat
- Red beans
- Caramel with dyes
- Green leafy crops (lettuce, dill, broccoli, spinach)
If you consumed something from the above list, then the stool may have a dark green tint for another 5 days. Bright green stool indicates the presence of a large number of additives and dyes in the food you eat.
Quite often, vegetarians have green stool, because... They include a large amount of fruits and vegetables in their daily diet, which can trigger the formation of this color.
Etiology and pathogenesis
· Free, unbound iron is toxic to living tissue and can locally destroy the intestinal mucosa.
· 10% of ingested iron (Fe 2+) is actively absorbed as ions in the small intestine. After absorption, iron accumulates as Fe3+ in the mucosal storage protein ferritin. From there, iron is transported to the liver, spleen and bone marrow for further storage in ferritin or for inclusion in the heme molecule.
· Iron is transported bound to the transport protein transferrin.
· When the blood's ability to bind iron is exceeded (serum iron > 90 µmol/L), free ions lead to tissue damage in most organs, including the liver and heart.
Diagnostics
Diagnostic criteria
· History of toxic iron intake.
· Some patients develop symptoms after taking 20 mg Fe/kg body weight.
· Severe poisoning most often occurs after ingestion of > 40 mg Fe/kg body weight.
· S-Fe>90 µmol/l indicates severe poisoning, but it is also worth considering the clinic and the time elapsed after administration.
Patients with symptoms should be treated regardless of the amount consumed.
Disease history
Questions to ask the patient when taking a history:
- How many tablets were taken and for how long?
- What type of preparation?
- How long has it been since you used it?
- Has the patient also taken alcohol, drugs, or other pills?
- Does the patient have any signs of hematemesis or blood in the stool?
- Did you try to induce vomiting? How successful?
When calculating iron intake, it is necessary to take into account the iron content in the tablets (ferrous sulfate 20%, ferrofumarate 33%).
Estimating how many pills a child has taken is often wrong.
What does black stool mean?
Possible causes of black stool may be pathologies of the stomach and intestines, complications of serious diseases.
What to do if an adult or child has black stool:
- Analyze a set of foods eaten over the past few days;
- Over the course of several days, observe changes in the color, consistency and frequency of stool.
The list of products should include all drinks, vitamins, and medications taken by a person. If the reason for the change in the color of feces is certain foods or medications, there is no need to fear that negative changes have occurred in the body.
It could be:
- Beet,
- Grape,
- Prunes,
- Activated carbon,
- Medicines containing iron.
It is important to carefully study the instructions for use of the medicine in order to anticipate such side effects as a black tint of feces.
If the set of foods consumed has not changed recently, and there is no need to take medications, if black stool appears, you should urgently seek medical help. A possible reason for such changes is internal bleeding caused by taking medications that reduce blood clotting. They do not change the color of feces, but provoke bleeding in the gastrointestinal tract, which is extremely dangerous if the patient is not given medical assistance in a timely manner.
If the normal color of stool changes to black due to the suspected use of foods or medications that stain feces, it is worth observing your stool. If, after removing a product from the diet or removing a medicine, the color of feces returns to normal after a few days, there is no need to worry about pathological changes in the body.
If after these measures changes in the color of the stool are periodically observed, and its consistency becomes liquid, you should undergo an examination to determine the cause of such changes.
Stages and characteristic symptoms
The manifestations of iron toxicity are usually described as five, often overlapping, phases:
- Gastrointestinal phase: from 30 minutes to 6 hours after oral administration. Symptoms: abdominal pain, vomiting, diarrhea, hematemesis, exhaustion, shock and metabolic acidosis. Vomiting is the most obvious indicator of severe poisoning at this stage. It occurs due to hypovolemic shock. Most patients with mild to moderate iron toxicity do not progress and symptoms resolve within 4 to 6 hours.
- Latent or relatively stable phase: 6 to 24 hours after administration. The latent phase gives the impression of improvement. It is short-lived or absent in people with severe poisoning.
- Shock and metabolic acidosis: 6 to 72 hours after ingestion. Shock, pallor, tachycardia, hypotension, coagulopathy may occur, and hepatotoxicity may further develop.
- Hepatotoxicity/liver necrosis: 12 to 96 hours after administration. Due to liver necrosis, intestinal obstruction occurs.
- Intestinal obstruction: 2-8 weeks after ingestion of Fe. Due to scarring of the gastrointestinal tract, especially at the exit from the stomach.
Clinical data
List of signs and symptoms
Stage 1 (1/2 to 1 hour after administration):
· Stomach ache.
· Vomiting and diarrhea, and bloody vomiting is not uncommon.
· Weakness, shock and metabolic acidosis may develop.
Stage 2 (6-12 hours after administration):
· Not everyone goes through this stage.
· Gastrointestinal symptoms may stop.
· This apparent recovery may provide false security.
Stage 3 (12-48 hours after administration):
· May occur early in case of serious poisoning or after the quiet phase of the 2nd course.
Metabolic acidosis and shock.
· Anemia.
· Necrosis.
· Kidney, liver and heart failure.
· Possibly fatal within 1-3 days.
Stage 4 (days to weeks after recovery):
· Obstruction of the gastrointestinal tract due to injury due to poisoning.
Additional Research
1. Determination of Fe concentration in the blood. Serum iron - useful to confirm Fe intake and to determine severity. High concentrations are not always associated with danger because they measure free circulating Fe while intracellular Fe causes systemic toxicity.
2. If serum Fe concentration is not readily available, the following may indicate serious toxicity:
Leukocytosis > 15 x 109.
· Hyperglycemia > 8.3 mmol/l.
· Diarrhea/vomiting.
· Detection of tablet residues using abdominal x-ray.
· Serum electrolytes, blood urea and serum creatinine.
· Glucose level.
3. Coagulation parameters (INR, prothrombin), determination of leukocyte formula. Blood gases should be obtained from a patient with severe symptoms.
4. Other studies. X-ray of the abdomen. The tablets are often X-ray resistant.
Reaction to food
One of the most common reasons why black stool in an adult is a reaction of the gastrointestinal tract to certain foods. What foods cause dark stool:
- dishes with beets;
- prune fruits;
- dark grape berries;
- natural red wine;
- pomegranate;
- red rowan;
- blueberries, blackberries, blueberries, black currants;
- blood sausage.
A dark shade of stool in men and women over 40-50 years of age may be the result of drinking low-quality alcohol in immoderate quantities. The black tint of feces means intoxication of the body. Abuse of strong coffee and black tea has a similar effect.
In some cases, the cause of a change in the color of feces may be a sudden change in the usual diet, and in pregnant women - taking Hematogen, prescribed for the treatment of iron deficiency anemia. If the darkening of the stool is not accompanied by a change in its consistency and an increase in body temperature, there is no reason to worry. Otherwise, you should definitely consult a doctor.
Internal hemorrhages of the gastrointestinal tract
Among the most common causes of darkening of stool in women over 40-50 years old are diseases of the gastrointestinal tract. These include varicose veins of the esophagus, gastric and duodenal ulcers, cancer of the digestive system, and Mallory-Weiss syndrome. Provoking factors also include ingestion of a foreign body and mechanical trauma to the gastrointestinal tract.
These diseases cause thinning and damage to the mucous walls of the digestive system, as well as bleeding. Because of this, the stool takes on a dark tint. In official medicine, this phenomenon is called “melena”. Internal bleeding against the background of a gastrointestinal tract disease can be determined by additional symptoms:
- regular stomach pain;
- frequent increase in body temperature;
- attacks of nausea and vomiting;
- weakness, lethargy and loss of strength.
The most alarming sign is vomiting with blood or dark spots resembling coffee grounds. This indicates severe internal bleeding. In such cases, emergency medical attention is required.
Varicose veins of the esophagus
Esophageal varicose veins are a dangerous condition in which the blood vessels become inflamed, lose their elasticity and begin to stretch. The initial stages of the disease are most often completely asymptomatic, so a person is not even aware of the development of varicose veins of the esophagus.
In the absence of timely treatment, blood vessels begin to overstretch, which ultimately leads to rupture of capillaries. The main manifestations of vascular rupture:
- bouts of vomiting with bloody spots;
- difficulty swallowing;
- a sharp decrease in blood pressure;
- weakness, loss of strength, attacks of dizziness;
- black color of stool.
Rupture of the blood vessels of the esophagus is accompanied by internal bleeding, which poses a serious danger to human life. An important role in the development of varicose veins of the esophagus is played by liver diseases - cirrhosis, the toxic effects of alcohol, and medications. When the first signs of esophageal varicose veins appear, you should contact a gastroenterologist, since advanced stages of this disease can lead to severe complications, including death.
Stomach or duodenal ulcer
With a peptic ulcer of the stomach and duodenum, the mucous walls of the digestive system are damaged, in which bleeding trophic ulcers appear on their surface. Dark feces in this disease do not appear immediately, but most often in advanced stages, with serious ulcerations of the gastrointestinal tract.
With severe internal bleeding, the stool becomes not only black, but also has a tarry consistency.
Feces become liquefied due to the passage of large amounts of broken down blood through the intestines. If the bleeding is small and the blood is released in a minimal volume, the stool does not become liquid.
Most often, darkening of the stool is observed during an exacerbation of peptic ulcer disease. This shade of stool may indicate an increased concentration of iron oxide in the gastrointestinal tract, which is the result of fermentation of hemoglobin in the digestive system. If black stool appears, you should immediately consult a doctor, since exacerbation of the ulcer has dangerous consequences for the gastrointestinal tract.
Liver diseases
Darkening of the stool is one of the signs of liver cirrhosis, in which liver tissue is damaged and dies. This disease directly affects the pigment “responsible” for the color of stool.
That is why in the initial stages of liver cirrhosis, the stool may be light or completely colorless.
In later stages, advanced cirrhosis causes severe internal bleeding that turns the stool dark. Features of stool in cirrhosis:
- bloody or mucous inclusions often appear in the stool;
- the consistency of the stool becomes liquid and mucous;
- feces are excreted in small quantities;
- the process of defecation is accompanied by severe discomfort or pain;
- frequent diarrhea gives way to constipation;
- pain, burning and discomfort in the anal area persist for some time after visiting the toilet.
In addition, with this liver disease, the hemorrhoidal veins expand, which over time begin to become inflamed and burst. Impurities of blood appear in the stool, which gives it a blackish tint.
Stomach cancer
Stomach cancer is one of the most dangerous and severe diseases of the digestive system, which most often develops in men and women over 40-50 years of age. With this disease, there is a rapid proliferation of malignant cells in the tissues lining the mucous membranes of the stomach.
The main danger of gastric cancer is that most often in the initial stages it is asymptomatic and is detected already in advanced stages, when drug therapy does not produce results. That is why early detection of stomach cancer increases the chances of curing it both medically and surgically. The disease goes through 4 stages:
- Stage 1
- the gastric mucosa is affected; - Stage 2
- the submucosal layer of tissue is affected; - Stage 3
- cancer affects the muscle layer; - Stage 4
- affects all tissues down to the outer layer.
The discharge of blackened feces during cancer indicates internal hemorrhage and can be combined with spasmodic contractions in the upper abdomen. Very often, cancer is accompanied by dyspeptic symptoms that appear immediately after eating - attacks of nausea, belching, bloating and a feeling of fullness.
Cancer of the rectum
Malignant lesions of the rectum are most often diagnosed in people over 45-50 years of age. But official medical statistics confirm that today this disease has noticeably “rejuvenated” - rectal tumors are increasingly common in men and women under 43 years of age.
In the early stages of the disease, the cancer affects only the intestinal walls, but as the disease progresses, it grows and can block the intestinal lumen. This leads to serious disruptions in the functioning of the entire digestive system. The malignant neoplasm presses on the walls of the rectum, causing the release of blood and mucus.
They enter the feces and are excreted from the body - this is what gives the stool a black tint.
The appearance of black stool during rectal cancer is an alarming sign indicating the development of dangerous complications. It is necessary to carefully monitor the condition of the gastrointestinal tract and at the first appearance of dark spots in the stool, be sure to consult a doctor.
Principles of therapy
The primary goal of treatment is to prevent complications. For this:
1. Aspiration and gastric emptying are performed. Vomiting is induced if <1 hour has passed since taking the tablet. This will remove iron from the digestive tract before it is absorbed. Radiologically proven Fe tablets in the stomach are indicative of lavage. Please note that the procedure is contraindicated if the patient is vomiting blood.
2. Patients who are asymptomatic when taken within 6 hours and who show no signs of clinical toxicity do not require treatment.
3. Patients with rare symptoms require only symptomatic treatment.
4. Intravenous hydration for all patients with significant symptoms. Treatment with intravenous fluid to maintain fluid balance is important because hypovolemic shock is a leading cause of premature death from toxicity.
5. Check your blood pressure and heart rate regularly, and control your breathing.
6. The antidote for poisoning is Deferoxamine. This drug increases iron excretion (Fe-binding antidote) and is indicated for severe iron poisoning.
7. If the patient is unaffected after several hours of observation and serum Fe remains low, he is discharged.
General symptoms in the presence of black stools
A person whose stool has changed color may experience changes in appearance, mood, and well-being. Looking from the outside at an adult or child with such a symptom, it is easy to see whether his appearance remains the same or has become painful. The absence of discomfort and good health due to the use of certain foods or medications that provoke the appearance of a black tint of feces confirms the normal state of health.
The following manifestations indicate that the patient needs the help of a doctor:
- Heartburn,
- Nausea and vomiting;
- Alternating constipation and diarrhea;
- Pain in the epigastric region.
You should be wary if you have a history of hepatitis, cancer, cirrhosis, or stomach ulcers. It is possible that the black color of feces is a sign of complications of existing diseases.
Dangerous symptoms that occur due to changes in stool color:
- Increased body temperature;
- A history of gastric or duodenal ulcers, cirrhosis, or cancer;
- Nausea and vomiting;
- Alcohol poisoning accompanied by severe vomiting shortly before the appearance of black stool;
- Repeatedly detected anemia in blood tests.
Treatment regimen
- Deferoxamine. It binds to Fe and forms a water-soluble compound, ferrioxamine, which is excreted in the urine. She turns pink.
- Deferoxamine is given intravenously in the hospital if severe gastrointestinal symptoms, shock, or coma develop.
- Continuously given equivalent to 15 mg/kg/hour. The dose may be increased to a maximum of 35 mg/kg/hour depending on severity.
Typically, treatment lasts about 24 hours. Side effects may include hypotension and acute respiratory distress syndrome.
Causes of black stool
The color of feces black when consuming certain foods or medications can be either uniform or have a granular structure. Dark spots in the stool are the remains of undigested food and drugs that give color to the stool as a result of a biochemical reaction.
Sometimes parents panic when they find black worms in their child’s stool, mistaking them for worms. Meanwhile, these are the undigested remains of the banana eaten the day before. Parasites are almost always light in color.
The black tint of feces in some cases indicates the presence of internal bleeding in the gastrointestinal tract. It can be caused by an ulcer, polyps, or varicose veins of the esophagus. After blood enters the stomach, it is exposed to gastric juice and its color changes from red to black. The stool takes on the same color. Additional symptoms of this pathology are pallor, weakness, dizziness. If they appear, you should immediately seek medical advice.
Causes of blood in stool:
- Ulcerative colitis,
- Crohn's disease,
- Acute form of lymphoblastic leukemia;
- Gastritis,
- Ankylostomiasis,
- Histoplasmosis.
When bleeding in the lower intestines, the blood does not undergo transformation and ends up in the feces, maintaining a red color. With weak intestinal motility, blood from the bleeding site, even located at the beginning of the colon, turns the stool black. In this case, hemoglobin in the blood is converted into hemin, which has a dark color.
If black stool appears immediately after surgery, dark stool indicates internal bleeding and the need for immediate medical attention. If the stool is black in color in combination with an elevated body temperature, the symptoms indicate a possible intestinal infection and the need for intervention by an infectious disease specialist.
Pregnancy is not a reason for changes in stool color and gastrointestinal disturbances, therefore, a similar symptom of a change in stool color in a woman expecting a child has the same reasons as in the normal state.
Progress, complications and prognosis
Gradient
The clinic is divided into four stages, which may overlap.
- Often transient symptoms such as lethargy, nausea, vomiting, diarrhea, abdominal pain. Leftover pills cause gray/black vomit and stool. Symptoms disappear after 6-8 hours. When consumed in large quantities, the local effect causes bloody diarrhea.
- Symptom of free interval pg transport and distribution of absorbed iron.
- The acute phase is observed in few patients. It manifests itself in the form of metabolic acidosis, shock, renal failure, and liver necrosis. Possible death within 1-3 days.
- Tension in the gastrointestinal tract due to damage. Complications: hypotension, shock, metabolic acidosis, liver and kidney failure, gastric fibrosis and pyloric obstruction.
Forecast
- The prognosis can be serious, but in most cases the poisoning is not life-threatening.
- Toxic doses for 2-3 years: 400 mg Fe2+.
- Lethal doses: 50 - 300 mg Fe2 + / kg.
- Patients who are alive 72 hours after administration make a full recovery.
Pathological causes of the formation of green feces in adults and children
There can be many reasons that provoke the appearance of green fecal matter. Most of them indicate a disturbance in the functioning of the intestines or other organs.
It is noteworthy that the bile secreted by the gallbladder is bright green. As it passes through the intestines, the color of the bile becomes darker and eventually its color becomes dark brown.
But there is one “but”: if bile moves through the intestines quite quickly, then its color simply does not have time to change its color, and it remains green. The most common reasons for the rapid movement of bile through the intestines:
- Giardia
- Salmonellosis
- Food poisoning
- Food allergies
- Rotavirus infection
- Crohn's disease
- Celiac disease
- Ulcer in the gastrointestinal tract
- Diabetes
- Inflammatory process in the small intestine
- Thyrotoxicosis
These are just some of the reasons why a person may have green fecal matter. You should immediately consult a doctor if green stool is accompanied by pain in the small or large intestine, as well as increased body temperature and vomiting.
Helpful information
Find out more about poisonings, their symptoms, treatment regimens, antidotes and consequences:
- Acetylsalicylic acid.
- Carbon monoxide: signs, symptoms, treatment.
- Benzodiazepines.
- Benzodiazepine-like hypnotics.
- Beta blockers.
- Lead, fluorine.
- Calcium antagonist.
- Cardiac glycosides.
- Ethanol.
- Ethylene glycol.
- Histamine
