In the second stage (6-24 hours post-ingestion), GI symptoms resolve but patients may have volume depletion and metabolic acidosis. Hematemesis and hematochezia may occur in more severe cases. The first stage is within the first 6 hours after ingestion and consists of primarily GI symptoms including abdominal pain, nausea, vomiting, and diarrhea. Iron toxicity is divided into 5 stages, although patients may not experience every stage and may skip stages as well. Patients who ingest 20-60 mg/kg of elemental iron may develop nausea and vomiting but are at a low-risk for severe toxicity, while > 60 mg/kg is associated with a high-risk for severe toxicity and death. 3 As an example, a 325 mg tablet of ferrous sulfate contains 65 mg of elemental iron. The following iron salts are commonly found over-the-counter: ferrous sulfate (20% elemental iron), ferrous gluconate (12% elemental iron), and ferrous fumarate (33% elemental iron). In addition, there are enteric-coated formulations that may delay absorption. 2 The toxicity of iron depends on the amount of elemental iron ingested, and elemental iron amounts vary between products. Iron can cause direct injury to gastrointestinal mucosa, vasodilation, and impairment of cellular metabolism in the heart, liver, and central nervous system by disrupting oxidative phosphorylation and formation of free radicals. Also in 2020, there were about 8800 single cases of ingestion of a multivitamin formulation containing iron. In 2020, 4688 single cases of iron ingestion (as iron or iron salt formulations) were reported to US poison centers, with 2004 of those cases being in children under the age of 5 years. Call the Utah Poison Control Center at 1-80 at any time 24/7 for assistance in managing iron toxicityĪlthough iron ingestion is no longer the leading cause of poisoning deaths, it is not uncommon and can be a potentially fatal toxicologic emergency.Deferoxamine is indicated in severe iron toxicity, and whole bowel irrigation may be indicated if tablets can be seen on KUB.Ferritin and TIBC have no role in overdose. Only a serum iron is useful in assessing acute toxicity.
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