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Iron Toxicity Follow-up

  • Author: Clifford S Spanierman, MD; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Dec 04, 2015
 

Further Inpatient Care

Deferoxamine (Desferal) can be used to chelate iron.[4] Patients who are symptomatic should receive deferoxamine regardless of their iron level.

In acute iron poisoning, intramuscular (IM) administration is indicated for patients who are not in shock; intravenous (IV) administration should be reserved for patients in a state of cardiovascular collapse or shock. However, note that rapid IV administration of deferoxamine may itself result in hypotension and shock. For chronic iron overload, administration can be subcutaneous, IV, or IM. Aggressive hydration aids in eliminating chelated iron by maintaining an appropriate urine output.

Other features of inpatient care are as follows:

  • Conservative management may be adequate in severe intoxication.[5]
  • Persistently symptomatic patients with serum iron levels higher than 350 mcg/dL should be admitted.
  • Patients who have been hemodynamically unstable, and those with serum iron levels higher than 1000 mcg/dL, should be admitted to a facility that can provide age-appropriate intensive care.
  • Other modalities that may be essential include mechanical ventilation and blood product transfusions.
  • Exchange transfusion has been reported to be successful in management of a case of severe iron poisoning.[6]
  • Hemodialysis has been used in severe intoxications.[7]
  • Iron bezoars may be removed laparoscopically or endoscopically.[8, 9]
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Transfer

Transfer patients if intensive care or deferoxamine is not available locally.

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Complications

Complications of iron toxicity include the following:

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Patient Education

Safekeeping of all medications, not just iron pills, from young children is important. Common medicines and vitamins may be lethal. Also see Vitamin Toxicity.

For patient education information, see the First Aid and Injuries Center, as well as Iron Poisoning in Children and Poison Proofing Your Home.

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Contributor Information and Disclosures
Author

Clifford S Spanierman, MD Consulting Staff, Departments of Emergency Medicine and Pediatrics, Lutheran General Hospital of Oak Brook, Advocate Health System

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Undersea and Hyperbaric Medical Society, Wilderness Medical Society, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

David C Lee, MD Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. McGuigan MA. Acute iron poisoning. Pediatr Ann. 1996 Jan. 25(1):33-8. [Medline].

  2. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015 Dec. 53 (10):962-1147. [Medline]. [Full Text].

  3. [Guideline] Höjer J, Troutman WG, Hoppu K, Erdman A, Benson BE, Mégarbane B, et al. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (Phila). 2013 Mar. 51(3):134-9. [Medline].

  4. Tenenbein M. Benefits of parenteral deferoxamine for acute iron poisoning. J Toxicol Clin Toxicol. 1996. 34(5):485-9. [Medline].

  5. Sankar J, Shukla A, Khurana R, Dubey N. Near fatal iron intoxication managed conservatively. BMJ Case Rep. 2013 Jan 31. 2013:[Medline].

  6. Carlsson M, Cortes D, Jepson S, Kansstrup T. Severe iron intoxication treated with exchange transfusion. Arch Dis Child. April 2008. 93(4):321-2. [Medline].

  7. Gumber MR, Kute VB, Shah PR, et al. Successful Treatment of Severe Iron Intoxication with Gastrointestinal Decontamination, Deferoxamine, and Hemodialysis. Ren Fail. 2013 May 1. [Medline].

  8. Ng HW, Tse ML, Lau FL, Chu W. Endoscopic removal of iron bezoar following acute overdose. Clin Toxicol (Phila). 2008 Nov. 46(9):913-5. [Medline].

  9. Haider F, De Carli C, Dhanani S, Sweeny B. Emergency laparoscopic-assisted gastrotomy for the treatment of an iron bezoar. J Laparoendosc Adv Surg Tech A. April 2009. 19 Suppl 1:S141-3. [Medline].

  10. Cerezo A, Costan G Gonzale A, Galvez C , Garcia V, Iglesias E, Reye A, et al. Severe esophagitis due to overload of iron tablets. Gastroenterol Hepatol. Oct 2008. 31(8):551-2. [Medline].

  11. Valentine K, Mastropietro C, Sarnaik AP. Infantile iron poisonings: challenges in diagnosis and management. Pediatr Crit Care Med. May 2009. 10 (3):e31-33. [Medline].

  12. Atiq M, Dang S, Olden KW, Aduli F. Early endoscopic gastric lavage for acute iron overdose: a novel approach to accidental pill ingestions. Acta Gastroenterol Belg. 2008 Jul-Sep. 71(3):345-6. [Medline].

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