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Iron Poisoning

Iron Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • 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


Elemental iron ingestion:
  • 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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Rosen, Peter, et al., editors. "Iron Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning.
Iron Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning. Accessed April 24, 2019.
Iron Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning
Iron Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Iron Poisoning ID - 307253 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307253/all/Iron_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -