II. Precautions
III. Pathophysiology: Iron Toxicity
- Stage 1: Gastrointestinal (0.5 to 6 hours)
- Abdominal Pain
- Nausea and Vomiting
- Diarrhea
- Hematemesis
- Melana
- Lethargy
- Stage 2: Latent Period (6 to 24 hours)
- Metabolic Acidosis may be present
- Lethargy may be present
- Hypotension may be present
- Stage 3: Systemic Toxicity and Shock (4 to 40 hours)
- Cyanosis
- Hypovolemia and Hypotension (shock)
- Lactic Acidosis
- Lethargy
- Restlessness
- Disorientation to Coma
- Convulsions
- Coagulopathy
- Stage 4: Late Complications (>40 hours)
- Hepatotoxicity (onset within 48 hours)
- Gastric outlet obstruction or Small Bowel Obstruction (2-8 weeks)
IV. Labs
- See Overdose
- Serum Iron levels predict severity of ingestion
V. Management
- ABC Management
- Contact poison control
- Initial emergent supportive care for shock
- Crystalloid (NS or LR) replacement for hypovolemia
- Transfuse pRBCs
- Correct Metabolic Acidosis
- Discuss Gastric Decontamination with poison control
- Whole Bowel Irrigation may be recommended (Polyethylene glycol 25 ml/kg/h for 6-10 hours)
- Deferoxamine Chelation
- Indications (once hemodynamically stable)
- Vomiting, diarhea and signs of shock
- Peak iron level >500 mcg/dl (90 mmol/L)
- Peak iron level >350 mcg/dl AND symptomatic
- Pills seen on abdominal XRay
- Protocol
- Deferoxamine started at 5 mg/kg/h and observe for Hypotension over the subsequent hour
- May titrate to a maximum of 15 mg/kg/h while closely observing for Hypotension
- Some cases have used doses as high as 50 mg/kg/h in very severe Poisonings
- Obtain iron levels every 2-3 hours
- Discontinue Deferoxamine when iron level <350 mcg/dl (62 mmol/L) and asymptomatic
- Indications (once hemodynamically stable)
VI. Prognosis
-
Serum Iron at 2-6 hours after ingestion
- Serum Iron <300 mcg/dl predicts benign course
- Serum Iron >500 mcg/dl predicts severe course
VII. References
- Gossman (2016) Emergency Medicine Oral Board Review, p. 207-9
- (2016) CALS Manual, 14th ed, I-137
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Related Studies
| 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 |
