Iron Poisoning
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T45.4 DESCRIPTION Iron is widely available as an over-the-counter product and is commonly ingested accidentally by toddlers. DIAGNOSTIC CRITERIA Toxicity is related to the ingested dose of elemental iron. A single dose of elemental iron > 20 mg/kg requires hospital assessment and mana
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: T45.4
DESCRIPTION
Iron is widely available as an over-the-counter product and is commonly ingested accidentally by toddlers.
DIAGNOSTIC CRITERIA
- Toxicity is related to the ingested dose of elemental iron.
- A single dose of elemental iron > 20 mg/kg requires hospital assessment and management.
Clinical
- gastrointestinal features,
- coma,
- shock and metabolic acidosis,
- hepatic necrosis.
Elemental iron per preparation:
| Iron product | Strength | Elemental content | Elemental content per mL or tablet |
| Ferrous gluconate syrup | 350 mg/5 mL | 40 mg elemental iron per 5 mL | 8 mg elemental iron per mL |
| Ferrous lactate drops | 125 mg/mL | 25 mg elemental iron per mL | 25 mg elemental iron per mL |
| Ferrous sulphate compound tablets | 170 mg | 55 mg elemental iron per tablet | ± 55 mg elemental iron per tablet |
Categories of iron toxicity:
| Low risk | Medium risk | High risk |
|
No history of:
Asymptomatic for 6 hours.
|
Clinical features of toxicity and serum iron > 300 mcg/dL (60 µmol/L).
|
Any of these features present:
|
- Low risk patients are unlikely to have ingested enough iron to lead to serious poisoning and can be discharged.
- Admit high and medium risk patients.
Investigations
Medium and high risk:
- Abdominal X-ray; if history is uncertain or to assess the efficacy of gut decontamination.
- Arterial blood gas.
- Serum electrolytes.
- Liver function test.
- Serum iron levels within 2–6 hours after ingestion.
GENERAL AND SUPPORTIVE MEASURES
General supportive treatment, including airway management if required.
MEDICINE TREATMENT
Medium and high risk
Fluid resuscitation:
- Sodium chloride 0.9%, IV, 20 mL/kg as an initial bolus followed by maintenance therapy.
If no signs of gastrointestinal dysfunction e.g. perforation/haemorrhage:
- Whole bowel irrigation is recommended if:
- > 60 mg/kg elemental iron has been ingested.
- Modified-release preparations are ingested.
- Undissolved tablets are still visible on abdominal X-ray.
Chelation therapy
All medium and high-risk cases (see table above).
For iron ingestion > 60 mg/kg of elemental iron:
- Desferrioxamine, IV, 15 mg/kg/hour as a continuous infusion until acidosis is resolved and urine is no longer pink.
- Beware of hypotension.
REFERRAL
- All medium and high-risk cases should be managed in a high care unit or ICU with access to serial serum iron measurement. Chelation therapy should be initiated prior to urgent referral/transfer.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 18: Poisoning, 18.1 Poisoning, 18.1.7 Iron Poisoning