Iron Poisoning

Description

General measures

Medicine treatment

Referral

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T45.4 + (X44.99/X64.99/Y14.99)

DESCRIPTION

Iron is a commonly prescribed drug, especially in pregnancy, and in overdose causes initial gastrointestinal toxicity. Patients may have a stage of “apparent recovery” 6–36 hours post-ingestion. This should not be confused with true recovery as patients may subsequently deteriorate.

Significant exposure may be associated with:

• severe vomiting and diarrhoea
• gastrointestinal haemorrhage
• metabolic acidosis,
• hypotension, shock
• CNS depression,
• renal failure, and
• hepatitis.

Ferrous salt	Amount	Elemental iron
Ferrous sulphate	170 mg	±65 mg
Ferrous gluconate	300 mg	35 mg
Ferrous fumarate	200 mg	±65 mg

Table 19.4: Elemental iron content available in different iron salts

GENERAL MEASURES

• Gastrointestinal decontamination by whole bowel irrigation is recommended:
  • if >60 mg/kg elemental iron has been ingested
  • if modified-release preparations ingested
  • undissolved tablets still visible on abdominal X-ray
• Activated charcoal does not bind iron and is not indicated in isolated iron overdose.
• Serum iron concentration should be measured 4–6 hours after ingestion and repeated every 6 hours until peak. The use of deferoxamine (desferrioxamine) interferes with the interpretation of further serum iron levels.
• Give intravenous fluids for hypotension.

MEDICINE TREATMENT

Chelation therapy

• Patients with serum iron levels <54 μmol/L and absence of symptoms >6 hours after overdose do not require chelation therapy.
• Deferoxamine (desferrioxamine) may be used for the following indications (if in doubt, consult the Poisons Information Helpline):
  • Severe symptoms (altered mental status, haemodynamic instability, metabolic acidosis).
  • Serum iron concentration >90 μmol/L.
  • Peak serum iron concentration >60 μmol/L, AND persistent gastrointestinal symptoms.

LoE:IIIa^xxxviii 

LoE:IVb^xxxix 

• Deferoxamine (desferrioxamine), IV infusion, 80 mg/kg.
  • Administer at 15mg/kg/hour over about 6 hours.
  • Beware of hypotension.
  • Where IV access is not obtainable, deferoxamine can be given by IM injection as follows: deferoxamine, IM injection 1 g immediately, followed by 500 mg every 4 to 12 hours, as needed based on clinical response.
  • For cardiogenic shock, the IV route is preferred and should be used as soon as IV access is possible.
  • Deferoxamine can be used in pregnant women.

LoE:IIIa^xl 

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Note:
- Prolonged use (>24 hours) of high doses are associated with acute lung injury and should be avoided. However, additional doses may be required in severe poisonings
- A benefit-risk assessment is required in these patients.

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REFERRAL

Haemodialysis may be needed to remove deferoxamine-iron complexes in patients with renal insufficiency.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 2.0_27 March 2025

Chapter 19 Poisoning_19.7 Iron Poisoning