Iron Toxicity Follow-up
- Author: Clifford S Spanierman, MD; Chief Editor: Asim Tarabar, MD more...
Further Inpatient Care
Deferoxamine (Desferal) can be used to chelate iron. 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.
- 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.
- Hemodialysis has been used in severe intoxications.
- Iron bezoars may be removed laparoscopically or endoscopically.[8, 9]
Transfer patients if intensive care or deferoxamine is not available locally.
Complications of iron toxicity include the following:
- Hepatic necrosis
- Myocardial dysfunction
- CNS depression
- Sepsis (Yersinia infection)
- Gastrointestinal perforation
- Intestinal stricture formation
Safekeeping of all medications, not just iron pills, from young children is important. Common medicines and vitamins may be lethal. Also see Vitamin Toxicity.
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