Iron Toxicity in Emergency Medicine Follow-up
- Author: Clifford S Spanierman, MD; Chief Editor: Asim Tarabar, MD more...
Further Inpatient Care
- Treat patients who are symptomatic with deferoxamine, regardless of iron level.
- Admit patients who have been hemodynamically unstable to an intensive care unit.
- Whole-bowel irrigation may be of benefit.
- Other modalities that may be essential include mechanical ventilation and blood product transfusions.
- Aggressive hydration aids in eliminating chelated iron by maintaining an appropriate urine output.
- Exchange transfusion has been reported to be successful in management of a case of severe iron poisoning.[3]
- Iron bezoars may be removed laparoscopically or endoscopically.[4, 5]
Further Outpatient Care
- Asymptomatic patients observed for 6 hours with serum iron levels less than 300-350 mcg/dL may be discharged.
Transfer
- Transfer patients if intensive care facilities or deferoxamine is not available locally.
Deterrence/Prevention
- Safekeeping of all medications, not just iron pills, from young children is important.
Complications
Complications of iron toxicity include the following:
- Hepatic necrosis
- Myocardial dysfunction
- CNS depression
- Coma
- Convulsion
- Anemia
- Coagulopathy
- Sepsis (Yersinia infection)
- Gastrointestinal perforation
- Intestinal stricture formation
Prognosis
- Persistently symptomatic patients with serum iron levels higher than 350 mcg/dL should be admitted.
- Patients with serum iron levels higher than 1000 mcg/dL should be in a facility that can provide age-appropriate intensive care.
Patient Education
- Common medicines and vitamins may be lethal. Also see Toxicity, Vitamin.
- All medicines should be kept out of reach of children.
- For excellent patient education resources, visit eMedicine's Poisoning - First Aid and Emergency Center. Also, see eMedicine's patient education articles Iron Poisoning and Poison Proofing Your Home.
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