Iron poisoning

What it is

Iron overdose is sized by the dose of elemental iron. A dose ingested above 20 mg/kg of elemental iron, or an unknown amount, is what puts the patient into the management. Clinical features depend on the time of presentation, so the hour of the ingestion is part of what is obtained, not background to it.

How it is diagnosed

Obtain the time of ingestion, the current symptoms, the exact elemental iron concentrations and the amount ingested, the age and weight of the patient, the current medications, the medical problems and any previous therapy.

Then the patient goes down one of three branches.

• Asymptomatic: consider WBI, obtain a KUB x-ray, and obtain a serum iron level 4 hours post ingestion. A patient who is still asymptomatic at 6 hours postingestion is discharged.
• Only GI symptoms: volume resuscitation, assess the acid-base status, obtain a KUB x-ray, consider WBI, and obtain a serum iron level 4 hours post ingestion.
• Systemic toxicity: stabilize the patient, volume resuscitation, assess the acid-base status, obtain a serum iron level and a KUB x-ray, and consider WBI.

The serum iron level then divides the management. Below 500 microg/dL, or unavailable, with a normal acid-base status and no symptoms, the patient goes back to the asymptomatic at 6 hours postingestion box and from there to discharge. Above 500 microg/dL, which is the toxic level, or with metabolic acidosis, or with symptoms that persist or that develop, deferoxamine IV is started.