Lightning Learning: Iron Overdose

““Careful calculation of elemental iron is important to determine toxicity. Severe overdose can range from 75-150 mg/kg and be potentially fatal.””

— advice is based on local guidelines & procedures

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What?

This is the elemental iron that is important to calculate as other iron formulations contain different amounts of elemental iron.

>20 mg/kg – features likely

>75 mg/kg – severe features likely, can be fatal

>150 mg/kg – severe/fatal poisoning probable

Severe features include: reduced GCS, raised anion gap metabolic acidosis, seizures, GI bleed, haemolysis and shock.

Has a corrosive effect on GI tract which can cause D+V and haematemesis.

At high doses can be cardiotoxic and cause hepatocellular damage and metabolic acidosis.

Why?

For full management information, consult TOXBASE.

1. Activated charcoal does not bind iron so is of no use!

2. Bloods including – FBC, U&Es, LFTs, Coagulation, blood glucose, VBG serum iron concentration (at 4 hrs & 6 hrs post ingestion)

3. ECG

4. Fluid resuscitation

5. Desferrioxamine 15 mg/kg/hr – do not wait for blood results if clinical features are present.

6. Consider sodium bicarbonate if metabolic acidosis persists despite fluids.

Further Reading

• TOXBASE: Ferrous Sulphate
• LITFL: Iron Overdose
• OHSU: Tox Shorts: Iron Toxicity 🎬