IRON POISONING

Common in children, due to the candy-like aspect of iron tablets. Ingestion of a quantity <40 mg/kg of elemental iron is unlikely to cause problems. Doses >60 mg/kg can cause serious toxicity.

Note: the common tablet of 200 mg of an iron salt contains 60-65 mg of elemental iron.

Clinical features

  • Clinical symptoms vary according to the time from ingestion
TIME SYMPTOMS
Phase 1
(30 minutes
to 6 hours)
Initial symptoms (by corrosive action of
iron in GIT): nausea, vomiting (may be
blood stained), abdominal pain, shock,
metabolic acidosis
Phase 2
(6–12 hours)
Symptoms improve or disappear
Phase 3
(12-48 hours)
Severe shock, vascular collapse,
metabolic acidosis, hypoglycaemia,
convulsions, coma
Phase 4
(2-4 days)
Liver and renal failure, pulmonary
oedema
Phase 5
(>4 days)
Gastrointestinal scarring and
obstruction in survivors

Management

  • Gastric lavage if ingestion within 1 hour from arrival or pills visible in the stomach at X-ray
  • NB: charcoal is NOT EFFECTIVE
  • Patients who are asymptomatic after 6 hours from ingestion most likely do not need specific treatment. Monitor for at least 12 hours
  • IV fluids to manage shock and hypovolaemia
Indication for use of antidote:
    • Severe symptoms
    • Metabolic acidosis
  • Desferroxamine continuous infusion 15 mg/kg/ hour in normal saline or glucose 5%
    • Do not use for more than 24 hours
    • Increase IV fluids if BP drops
    • Continue until metabolic acidosis clears or clinical condition improves
    • Contraindication: renal failure/anuria