Folic Acid Toxicity

Two, 4 years old child come to hospital.

Brought by parents and teacher (They anxious).

Teacher claimed she found empty foil of 21 tablet Folic acid (5mg each tablet) while cleaning the playing area at kindergarten, with coins and other teacher wallet. (Luckily the teacher bring the empty foil for identification)

Upon questioning, two of the kids admit that they consume the pills. How much each of them consume, nobody know. But according to them, they do share the pills (sharing is caring).

TRIAGE?

The junior triager seem unsure where these kids should be triage. They ask you. Since the kids vital sign are normal and folic acid is generally non toxic, you triage the kids to green zone.

You see them immediately.

Both of them look active with normal vital sign. Look happy & playing.

What should you worry?

Since the empty pill foil was found with coins, any airway obstruction need to be rule out.

No GI symptoms, no SOB, talking in full sentences.

So far the kids look fine.

Reassure the parents and teacher the nature of folic acid & what will you do.

What is the next step? Should we take any blood investigation?

Generally folic acid is non toxic.

Folic acid a.k.a Vitamin B9. Vitamin B is water soluble. Water soluble vitamins are less toxic compare to fat soluble vitamins (A,D,E and K) since fat soluble vitamin has ability to accumulate in the body.

Iron containing vitamin is the most toxic especially in paediatric acute ingestion.

The RDAs for folic acid are as follows:

• Age 14 years and older – 400 mcg

• Pregnancy (14-50 y) – 600 mcg

• Lactation (14-50 y) – 500 mcg

The RDAs in children are as follows:

• Age 0-6 months (adequate intake) – 65 mcg

• Age 6-12 months (adequate intake) – 80 mcg

• Age 1-3 years – 150 mcg

Age 4-8 years – 200 mcg = 0.2mg

• Age 9-13 – 300 mcg

But there is no cut off point of toxicity.

Since we handling paediatric case, its better safe than sorry.

Basic investigation such as DXT, FBC, RP and LFT are enough to make sure we didn’t miss anything.

While waiting the results, childs remain active and playful.

The results come back normal and the kids was discharge.

Ref:

https://emedicine.medscape.com/article/819426-overview#a1

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