Iron Toxicity in Emergency Medicine Workup

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

Laboratory Studies

  • Measure steady-state serum iron levels at least 4 hours postingestion. levels drawn more than 6 hours after ingestion may underestimate toxicity caused by ferritin binding and redistribution of iron.
    • Mild-to-moderate toxicity generally manifests at levels of 350-500 mcg/dL.
    • Hepatotoxicity usually is observed at levels higher than 500 mcg/dL.
    • levels higher than 800 mcg/dL are associated with severe toxicity.
    • Samples drawn too early or too late postingestion may be unreliable.
    • In adults, hyperglycemia, leukocytosis, abdominal pain, and vomiting may be absent.
  • Glucose levels
    • Glucose levels exceeding 150 mg/dL are common with severe iron toxicity.
    • Following glucose levels is important because hepatic dysfunction may cause hypoglycemia.
  • Complete blood count
    • A white blood cell (WBC) count more than 15,000/mm3 is associated with severe iron poisoning.
    • A CBC is also helpful because anemia from blood loss may develop.
  • In addition to serum lactic acid levels (lactate), the arterial blood gas (ABG) measurements are useful in determining the existence and severity of a metabolic acidosis.
  • Coagulation studies are essential. Monitoring the prothrombin time may be helpful.
  • Perform liver function tests (LFTs). Hepatic dysfunction is common in severe iron poisoning because the liver is the first organ outside of the GI tract to encounter large iron load through the portal blood supply.
  • Electrolyte measurements and renal function tests assist in calculation of the anion gap and detection of electrolyte abnormalities and the presence of prerenal azotemia.
  • Lipase and amylase levels may document occasional pancreatic injury.
  • Obtain a pregnancy test in women of childbearing age.
  • Determine type and cross-matching.
  • Ferritin levels are helpful for chronic toxicity >1000 mcg/L.
  • Iron toxicity is one of the MUDPILES (M-methanol; U-uremia; D-DKA, AKA; P-paraldehyde, phenformin; I-iron, isoniazid; L-lactic [ie, CO, cyanide]; E-ethylene glycol; S-salicylates) that causes an acidosis with an increased anion gap.
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Imaging Studies

  • A kidneys, ureters, bladder (KUB) film can determine if radiopacities are present; iron tablets are radiopaque for a few hours postingestion. However, the absence of radiopacities does not rule out a significant or lethal ingestion.
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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.

References

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