II. Precautions

  1. Iron toxicity after acute ingestion is difficult to gauge
  2. Iron supplements in overdosage may be lethal in children (FDA black box warning)

III. Pathophysiology: Iron Toxicity

  1. Stage 1: Gastrointestinal (0.5 to 6 hours)
    1. Abdominal Pain
    2. Nausea and Vomiting
    3. Diarrhea
    4. Hematemesis
    5. Melana
    6. Lethargy
  2. Stage 2: Latent Period (6 to 24 hours)
    1. Metabolic Acidosis may be present
    2. Lethargy may be present
    3. Hypotension may be present
  3. Stage 3: Systemic Toxicity and Shock (4 to 40 hours)
    1. Cyanosis
    2. Hypovolemia and Hypotension (shock)
    3. Lactic Acidosis
    4. Lethargy
    5. Restlessness
    6. Disorientation to Coma
    7. Convulsions
    8. Coagulopathy
  4. Stage 4: Late Complications (>40 hours)
    1. Hepatotoxicity (onset within 48 hours)
    2. Gastric outlet obstruction or Small Bowel Obstruction (2-8 weeks)

IV. Labs

  1. See Overdose
  2. Serum Iron levels predict severity of ingestion

V. Management

  1. ABC Management
  2. Contact poison control
  3. Initial emergent supportive care for shock
    1. Crystalloid (NS or LR) replacement for hypovolemia
    2. Transfuse pRBCs
    3. Correct Metabolic Acidosis
  4. Discuss Gastric Decontamination with poison control
    1. Whole Bowel Irrigation may be recommended (Polyethylene glycol 25 ml/kg/h for 6-10 hours)
  5. Deferoxamine Chelation
    1. Indications (once hemodynamically stable)
      1. Vomiting, diarhea and signs of shock
      2. Peak iron level >500 mcg/dl (90 mmol/L)
      3. Peak iron level >350 mcg/dl AND symptomatic
      4. Pills seen on abdominal XRay
    2. Protocol
      1. Deferoxamine started at 5 mg/kg/h and observe for Hypotension over the subsequent hour
      2. May titrate to a maximum of 15 mg/kg/h while closely observing for Hypotension
        1. Some cases have used doses as high as 50 mg/kg/h in very severe Poisonings
      3. Obtain iron levels every 2-3 hours
        1. Discontinue Deferoxamine when iron level <350 mcg/dl (62 mmol/L) and asymptomatic

VI. Prognosis

  1. Serum Iron at 2-6 hours after ingestion
    1. Serum Iron <300 mcg/dl predicts benign course
    2. Serum Iron >500 mcg/dl predicts severe course

VII. References

  1. Gossman (2016) Emergency Medicine Oral Board Review, p. 207-9
  2. (2016) CALS Manual, 14th ed, I-137

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Poisoning by iron AND/OR its compounds (C0412842)

Concepts Injury or Poisoning (T037)
ICD9 964.0
ICD10 T45.4 , T45.4X1
SnomedCT 55381001
English Poisoning by iron and its compounds, Iron and its compounds, Poisoning - iron compound drug, Iron + iron compound poisoning, Poisoning-iron/compounds, Poisoning by iron and its compounds NOS, Poisoning by iron compound drug, Iron and iron compound poisoning, Poisoning by iron AND/OR its compounds (disorder), Poisoning by iron AND/OR its compounds, Poisoning by iron and its compounds, NOS
German Vergiftung: Eisen und dessen Verbindungen, Vergiftung durch Eisen und seine Verbindungen
Korean 철 및 그 복합물에 의한 중독
Spanish Intoxicación por hierro y sus compuestos, intoxicación por hierro Y/O sus compuestos (trastorno), intoxicación por hierro Y/O sus compuestos
Portuguese Intoxicação por ferro e seus compostos
Italian Avvelenamento da ferro e suoi composti
French Intoxication par le fer et ses composés
Dutch vergiftiging door ijzer en zijn componenten, IJzer en ijzerverbindingen
Czech Otrava železem a jeho sloučeninami
Hungarian Vas és vegyületei által okozott mérgezés