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Iron Ingestion

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Iron Ingestion, Iron Poisoning, Acute Iron Toxicity, Acute Iron Poisoning

  • 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)
  • Pathophysiology
  • Iron Toxicity
  1. Stage 1: Gastrointestinal
    1. Abdominal Pain
    2. Vomiting
    3. Diarrhea
  2. Stage 2: Stability (duration of hours)
    1. Metabolic Acidosis may be present
  3. Stage 3: Shock
    1. Hypovolemia and Hypotension
    2. Lactic Acidosis
  4. Stage 4: Hepatotoxicity (onset within 48 hours)
  • Labs
  1. See Overdose
  2. Serum Iron levels predict severity of ingestion
  • Management
  1. Initial emergent supportive care for shock
    1. Crystalloid (NS or LR) replacement for hypovolemia
    2. Correct Metabolic Acidosis
  2. Discuss Gastric Decontamination with poison control
    1. Whole Bowel Irrigation may be recommended
  3. Deferoxamine chelation
    1. Start once hemodynamically stable
  • 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
  • References
  1. (2016) CALS Manual, 14th ed, I-137