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©2013 UpToDate ® Print Email Acute iron intoxication: Rapid overview To obtain emergent consultation with a medical toxicologist, call the United States Poison Control Network at 1-800-222-1222, or access the World Health Organization's list of international poison centers ( www.who.int/gho/phe/chemical_safety/poisons_centres/en/index.html ). History What form of iron was ingested? Ferrous gluconate (12 percent elemental iron) Ferrous sulfate (20 percent elemental iron) Ferrous fumarate (33 percent elemental iron) How many mg/kg of elemental iron was ingested? When did the ingestion occur? Clinical features: overlapping phases of clinical manifestations Gastrointestinal phase: (30 minutes to 6 hours) abdominal pain, vomiting, diarrhea, hematemesis, melena, lethargy, shock (from capillary leak and third spacing), metabolic acidosis Latent: (6 to 24 hours) improvement in GI symptoms; may have poor perfusion, tachypnea, tachycardia Shock and metabolic acidosis: (4 hours to 4 days) hypovolemic, distributive, or cardiogenic shock with profound metabolic acidosis, coagulopathy, renal insufficiency/failure, pulmonary dysfunction/failure, central nervous system dysfunction Hepatotoxicity: (within 2 days) coma, coagulopathy, jaundice. Severity is dose dependent. Bowel obstruction: (2 to 4 weeks) vomiting, dehydration, abdominal pain, usually gastric outlet obstruction Diagnostic evaluation: for all patients with systemic symptoms, those who have ingested >40 mg/kg of elemental iron, and those for whom the amount of elemental iron ingested is unknown Serum iron concentration: measure serum iron concentration within 4 to 6 hours after ingestion (8 hours for extended release tablets) Arterial or venous pH Abdominal radiograph looking for radiopaque pills Other initial labs: electrolytes, BUN, creatinine, glucose, liver function tests, prothrombin, partial thromboplastin time, CBC with differential, type and cross match Management Secure airway and breathing Treat volume depletion aggressively with isotonic infusion Whole bowel irrigation: for all patients with a significant number of pills in stomach and small intestine on radiograph

Other initial labs: electrolytes, BUN, creatinine, glucose, liver function tests, prothrombin, partial thromboplastin time, CBC with differential, type and cross match Management Secure airway and breathing Treat volume depletion aggressively with isotonic infusion Whole bowel irrigation: for all patients with a significant number of pills in stomach and small intestine on radiograph Deferoxamine: continuous IV infusion (can cause hypotension). Begin at 15 mg/kg/hour. May increase to 35/mg/kg/hour during first 24 hours for severe ingestions. A toxicologist and/or regional poison control center should be consulted to determine the optimum dose of deferoxamine and duration of therapy. Treat in the following circumstances: Severe symptoms: altered mental status, hemodynamic instability, persistent vomiting, diarrhea Anion gap metabolic acidosis Serum iron concentration >500 mcg/dL Significant number of pills on x-ray