Iron Toxicity in Emergency Medicine Treatment & Management

  • Author: Clifford S Spanierman, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jul 27, 2011
 

Prehospital Care

  • This section only refers to the acute overdose.
  • IV access should be established immediately.
  • For patients who are hypovolemic, administer fluid boluses of 20 mL/kg of 0.9 isotonic sodium chloride solution or lactated Ringer (LR) solution.
  • Provide oxygen to patients in shock.
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Emergency Department Care

  • Assume that symptomatic patients are hypovolemic. Administer vigorous isotonic crystalloid therapy (eg, 0.9 isotonic sodium chloride solution, LR solution) in 20 mL/kg boluses to attain and maintain hemodynamic stability.
  • Gastric lavage with a large-bore orogastric tube or administration of ipecac syrup may remove iron from the stomach. However, ipecac is not used routinely for iron removal because it can mask clinical signs of iron toxicity (vomiting). Due to local caustic effect of iron, poisoned patients routinely are vomiting on their own performing self-decontamination even without ipecac.
  • Ideally, these treatments should be performed 1-2 hours postingestion or even later if evidence of iron products in the stomach is observed on a radiograph. Each modality has its disadvantages.
    • Iron has a gelatinous texture and may be difficult to remove by lavage. Bezoar formation may occur.
    • Ipecac is not routinely indicated. Significant ingestions of iron may cause hypotension and unstable vital signs, and ipecac may endanger the patient's airway as an aspiration risk. The only exception to the rule might be the patient who presents very early and with a very large amount of ingested iron where ipecac can expedite evacuation. Prolonged vomiting (more than 1 h) should be attributed to iron toxicity rather than to the effects of ipecac.
  • Perform whole-bowel irrigation in patients with a radiopacity on KUB until the radiopacity clears. Activated charcoal does not bind iron but should be utilized if co-ingestants are suspected.
  • Oxygen should be supplemented.
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Consultations

  • Consultation with a toxicologist is recommended.
  • Obtain a gastroenterology consultation for patients who have large iron bezoars.
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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

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.

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, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

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, 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.

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