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