Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 38-37: Iron Overdose + Key Features Download Section PDF Listen +++ ++ 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 + Clinical Findings Download Section PDF Listen +++ ++ 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 + Diagnosis Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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