Iron Poisoning
Basics
Description
Description
- Peak concentrations are 2–4 hr postingestion
- Serum concentrations not reliable if obtained >4–6 hr after ingestion:
- Enteric coated or sustained release – warrants serial levels
- Postabsorption: Iron redistributes into tissues, and fall in serum iron occurs as free iron shifts intracellularly resulting in cellular injury
- Injury patterns:
- Corrosive injury to intestinal mucosa may result in profound fluid loss (shock), hemorrhage, and perforation
- Liver receives largest load of iron because of portal venous circulation – (hemorrhagic periportal necrosis)
- Free iron:
- Concentrates in mitochondria, disrupting oxidative phosphorylation; catalyzes lipid peroxidation and free radical formation, resulting in cell death; increases anaerobic metabolism and acidosis
- Causes myocardial depression, venodilation, and cerebral edema
- Hydration of ferric form liberates 3 protons, resulting in acidemia
Etiology
Elemental iron ingestion:Etiology
- Nontoxic <20 mg/kg
- Moderate to severe >40 mg/kg
- Lethality possible >60 mg/kg
- Elemental iron equivalents:
- Ferrous sulfate, 20% (325 mg = 65 mg Fe)
- Ferrous gluconate, 12%
- Ferrous fumarate, 33%
- Prenatal vitamins vary from 60–90 mg elemental iron per tablet
- Children's vitamins may contain 5–18 mg elemental iron per tablet
Pediatric Considerations
- Historically notorious for the highest mortality rate among pediatric accidental exposures (adult iron products)
- Children's chewable iron products have been shown to be safe
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Citation
Schaider, Jeffrey J., et al., editors. "Iron Poisoning." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning.
Iron Poisoning. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning. Accessed December 1, 2024.
Iron Poisoning. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning
Iron Poisoning [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning.
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