Iron Toxicity Treatment & Management
- Author: Clifford S Spanierman, MD; Chief Editor: Asim Tarabar, MD more...
In patients with acute iron overdose, intravenous access should be established immediately. Patients who are hypovolemic should receive fluid boluses of 20 mL/kg of normal saline or lactated Ringer (LR) solution. Provide oxygen to patients in shock.
Emergency Department Care
Assume that symptomatic patients are hypovolemic. Administer vigorous volume therapy with isotonic crystalloids (eg, normal saline, LR solution) in 20 mL/kg boluses to attain and maintain hemodynamic stability. Give supplemental oxygen.
Gastric lavage with a large-bore orogastric tube may remove iron from the stomach. Ideally, lavage should be performed 1-2 hours postingestion, although later use may be appropriate if evidence of iron products in the stomach is observed on a radiograph. However, iron has a gelatinous texture and may be difficult to remove by lavage. Whole-bowel irrigation may be used in patients with a radiopacity on kidneys, ureters, bladder (KUB) plain radiographs, until the radiopacity clears.
Ipecac has been used for gastric decontamination in patients with iron poisoning. Ipecac might be considered when it can be administered within 60 minutes of iron ingestion, in an alert patient who has ingested a very large amount of iron. Ipecac is not used routinely for iron removal because it can mask clinical signs of iron toxicity (vomiting). Significant iron overdose may cause hypotension and unstable vital signs, in which case ipecac is contraindicated, as it may endanger the patient's airway as an aspiration risk.
The American Academy of Clinical Toxicology advises that the routine administration of ipecac in the emergency department should definitely be avoided. Some reports suggest that ipecac may offer possible benefits in rare situations involving iron poisoning; this may be a moot point, however, since the availability of ipecac is rapidly diminishing. In any case, iron toxicity itself typically causes vomiting, because of its caustic effect on the gastrointestinal mucosa, so iron-poisoned patients routinely perform self-decontamination even without ipecac.
Activated charcoal does not bind iron. However, it should be utilized if co-ingestants are suspected.
Asymptomatic patients observed for 6 hours with serum iron levels less than 300-350 mcg/dL may be discharged.
Consultation with a toxicologist is recommended. Obtain a gastroenterology consultation for patients who have large iron bezoars.
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