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Key Features

  • Most children's preparations contain 12–15 mg of iron per dose; most adult preparations contain 60–90 mg of iron per dose

  • Iron is corrosive to GI tract

  • Carbonyl iron

    • Powdered form of elemental iron

    • Not as irritating to the GI tract as the iron salts, and appears to be safer

  • Excessive circulating free iron has depressant effects on myocardium and on peripheral vascular resistance

Clinical Findings

  • Ingestion of < 30 mg of iron per kg of body weight usually produces only mild GI upset

  • Ingestion of > 40–60 mg/kg may cause

    • Vomiting

    • Hematemesis

    • Diarrhea

    • Hypotension

    • Metabolic acidosis

  • Death may occur from

    • Massive fluid losses and bleeding

    • Metabolic acidosis

    • Peritonitis from intestinal perforation

    • Sepsis

  • Fulminant hepatic failure may occur

Diagnosis

  • Serum iron levels > 350–500 mcg/dL are potentially toxic

  • Serum levels > 1000 mcg/dL usually associated with severe poisoning

  • Plain abdominal radiograph may reveal radiopaque tablets

Treatment

  • Treat hypotension aggressively with intravenous crystalloid solutions (0.9% saline or lactated Ringer solution)

  • Perform whole-bowel irrigation to remove unabsorbed pills, particularly when intact tablets are visible on abdominal radiograph

  • Activated charcoal not effective

  • For symptomatic toxicity, and particularly with markedly elevated serum iron levels (eg, > 800–1000 mcg/dL)

    • Administer 10–15 mg/kg/h of deferoxamine by constant intravenous infusion

    • Higher doses (up to 40–50 mg/kg/h) have been used in massive poisonings

    • Prolonged infusion (> 36–48 h) has been associated with acute respiratory distress syndrome

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