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For further information, see CMDT Part 40-37: Iron Overdose

KEY FEATURES

  • Most adult preparations contain 60–90 mg of iron per dose

  • Iron is corrosive to the gastrointestinal (GI) tract

  • Intracellular toxic effects of iron include disruption of Krebs cycle enzymes

  • 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

  • Acute liver 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

  • Emergency and supportive measures

    • 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

  • Deferoxamine

    • Selective iron chelator; not useful as an oral binding agent

  • For symptomatic toxicity, and particularly with markedly elevated serum iron levels (eg, > 800–1000 mcg/dL)Activated charcoal is not effective

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