Iron Poisoning

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 the 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

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

Acute liver failure may occur

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

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 is 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