eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Iron: Follow-up

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

Updated: Mar 26, 2009

Follow-up

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.2

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
  • Cardiogenic shock
  • CNS depression
  • Coma
  • Convulsion
  • Anemia
  • Coagulopathy
  • Sepsis (Yersinia infection)
  • Adult respiratory distress syndrome (ARDS)
  • 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

Miscellaneous

Medicolegal Pitfalls

  • Using serum iron levels instead of clinical evidence (eg, vomiting, hypovolemia, acidosis) to guide treatment of the patient is a pitfall.
  • Discharging a patient who is in stage 2 may lead to serious morbidity. Patients in stage 2 may appear well but still have the potential of cardiovascular collapse.
  • Obtaining a normal or low iron level more than 6 hours after an ingestion may be misleading. Redistribution of iron in tissues is the reason that the level is low. Toxicity is still possible. Treat the patient, not the numbers.

Special Concerns

  • Pregnancy: The lethal potential of severe intoxication without treatment of deferoxamine far outweighs the risk to the fetus.
 


More on Toxicity, Iron

Overview: Toxicity, Iron
Differential Diagnoses & Workup: Toxicity, Iron
Treatment & Medication: Toxicity, Iron
Follow-up: Toxicity, Iron
References
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References

  1. Morse SB, Hardwick WE Jr, King WD. Fatal iron intoxication in an infant. South Med J. Oct 1997;90(10):1043-7. [Medline].

  2. 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].

  3. Alymara V, Bourantas D, Chaidos A. Effectiveness and safety of combined iron-chelation therapy with deferoxamine and deferiprone. Hematol J. 2004;5(6):475-9. [Medline].

  4. Bosse GM. Conservative management of patients with moderately elevated serum iron levels. J Toxicol Clin Toxicol. 1995;33(2):135-40. [Medline].

  5. Cheney K, Gumbiner C, Benson B, Tenenbein M. Survival after a severe iron poisoning treated with intermittent infusions of deferoxamine. J Toxicol Clin Toxicol. 1995;33(1):61-6. [Medline].

  6. Goldberg sl. Novel treatment options for transfusional iron overload in patients with myleodysplatic syndromes. Leuk Res. Dec 2007;31:s16-22. [Medline].

  7. Hershko CM, Link GM, Konijn AM. Iron chelation therapy. Curr Hematol Rep. Mar 2005;4(2):110-6. [Medline].

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

  9. Mills KC, Curry SC. Acute iron poisoning. Emerg Med Clin North Am. May 1994;12(2):397-413. [Medline].

  10. Palatnick W, Tenenbein M. Leukocytosis, hyperglycemia, vomiting, and positive X-rays are not indicators of severity of iron overdose in adults. Am J Emerg Med. Sep 1996;14(5):454-5. [Medline].

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

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Further Reading

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Keywords

iron, iron poisoning, iron overdose, iron toxicity, Fe, vitamins, symptoms, treatment, causes, iron supplements, corrosive iron toxicity, cellular iron toxicity, iron ingestion, high iron levels, prenatal vitamins, elemental iron, chronic iron toxicity

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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.

Medical Editor

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, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & 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.

Managing Editor

John G Benitez, MD, MPH, FACMT, FACPM, FAAEM, Associate Professor, Department of Medicine, Clinical Pharmacology Division, Vanderbilt University; Managing Director, Tennessee Poison Center
John G Benitez, MD, MPH, FACMT, FACPM, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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