{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:44:58Z","timestamp":1777934698711,"version":"3.51.4"},"reference-count":11,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>Hand warmer packets are common products used to provide a portable, nonflammable heat source via the exothermic oxidation of iron. We present the first reported case of pediatric hand warmer packet ingestion in a three-year-old male who developed an elevated serum iron concentration (peak 335\u2005ug\/dL) and gastrointestinal injury after ingesting the contents of a HOTHANDS hand warmer packet. He was treated with endoscopic gastric foreign body removal and lavage, as well as proton-pump inhibitors and whole bowel irrigation. Hand warmer packs contain reduced elemental iron powder, which has been shown to have a more favorable safety profile when compared to iron salts. The mechanism of toxicity for reduced iron is unknown, though it is thought to be due to conversion to more toxic iron ions in an acidic environment. While the current adult literature suggests that ingestion of a single hand warmer packet is without significant risk, our case demonstrates that even a partial ingestion carries a significant risk of both iron toxicity and direct gastrointestinal caustic injury in a young child. This case demonstrates the need for multidisciplinary care and consideration of urgent endoscopic foreign body removal and gastric lavage followed by whole bowel irrigation to mitigate the potential of severe iron toxicity.<\/jats:p>","DOI":"10.1177\/10806032231222373","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T01:06:51Z","timestamp":1704848811000},"page":"70-73","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Oral Ingestion of an Iron-Containing Hand Warmer in a Pediatric Patient"],"prefix":"10.1177","volume":"35","author":[{"given":"Jeremy R.","family":"Hardin","sequence":"first","affiliation":[{"name":"Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA"},{"name":"VA San Diego Healthcare System, San Diego, CA"},{"name":"San Diego Division, California Poison Control System, San Diego, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, CA"},{"name":"Rady Children's Hospital, San Diego, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin A.","family":"Seltzer","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA"},{"name":"VA San Diego Healthcare System, San Diego, CA"},{"name":"San Diego Division, California Poison Control System, San Diego, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond T.","family":"Suhandynata","sequence":"additional","affiliation":[{"name":"Department of Pathology, UC San Diego Health, San Diego, CA"},{"name":"Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego Health, San Diego, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamata","family":"Sivagnanam","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, CA"},{"name":"Rady Children's Hospital, San Diego, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel R.","family":"Lasoff","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA"},{"name":"VA San Diego Healthcare System, San Diego, CA"},{"name":"San Diego Division, California Poison Control System, San Diego, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"issue":"5","key":"bibr1-10806032231222373","first-page":"243","volume":"45","author":"Wu ML","year":"2003","journal-title":"Vet Hum Toxicol."},{"key":"bibr2-10806032231222373","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-011-0169-z"},{"key":"bibr3-10806032231222373","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2011.607460"},{"key":"bibr4-10806032231222373","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2017.04.006"},{"key":"bibr5-10806032231222373","doi-asserted-by":"publisher","DOI":"10.1080\/15563650701711086"},{"key":"bibr6-10806032231222373","unstructured":"Air-activated heating packs of various styles. MSDS No. 26KF06. Heatmax Incorporated, Georgia USA, April 10, 2015."},{"issue":"4","key":"bibr7-10806032231222373","first-page":"171","volume":"89","author":"Boyd EM","year":"1963","journal-title":"Can Med Assoc J."},{"issue":"1","key":"bibr8-10806032231222373","first-page":"31","volume":"40","author":"Wu ML","year":"1998","journal-title":"Vet Hum Toxicol"},{"key":"bibr9-10806032231222373","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002822"},{"key":"bibr10-10806032231222373","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3182302604"},{"key":"bibr11-10806032231222373","doi-asserted-by":"publisher","DOI":"10.1177\/07482337221124666"}],"container-title":["Wilderness &amp; Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10806032231222373","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10806032231222373","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10806032231222373","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:31:16Z","timestamp":1777689076000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10806032231222373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,9]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1177\/10806032231222373"],"URL":"https:\/\/doi.org\/10.1177\/10806032231222373","relation":{},"ISSN":["1080-6032","1545-1534"],"issn-type":[{"value":"1080-6032","type":"print"},{"value":"1545-1534","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,9]]}}}