Acute iron poisoning
- Erica L Liebelt, MD, FACMT
Erica L Liebelt, MD, FACMT
- Professor of Pediatrics and Emergency Medicine
- University of Alabama at Birmingham School of Medicine
- Rana Kronfol, MD
Rana Kronfol, MD
- Assistant Professor of Pediatric Emergency Medicine
- Baylor College of Medicine
- Section Editors
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The epidemiology, pharmacology, clinical manifestations, evaluation, and management of acute iron ingestion are reviewed here. An overview of the evaluation and management is included (table 1). Iron deficiency, iron requirements, and iron balance are discussed separately. (See "Iron deficiency in infants and young children: Screening, prevention, clinical manifestations, and diagnosis" and "Iron requirements and iron deficiency in adolescents" and "Regulation of iron balance".)
Almost 16,000 iron exposures annually are reported in children less than six years of age in the United States . Although the overall number of exposures in this age group has remained stable, the number of major effects and death in children are improved when compared to the period from 1990 to 2000.
The epidemiology varies significantly by the type of ingestion:
●Unintentional ingestion — The vast majority of childhood iron poisonings are unintentional and result in no or minimal toxicity. The most serious exposures involve prenatal vitamins and pure iron preparations that contain ferrous sulfate tablets, which typically have significantly more elemental iron per tablet (60 to 65 mg) than other iron preparations. These tablets appeal to children because they are often brightly colored, sugar-coated, and have the appearance of candy [2-5]. In one population-based case-control study, the birth of a sibling within six months was identified as a risk factor for iron poisoning in children younger than three years of age (adjusted odds ratio [OR] 1.9, 95% CI 0.9-3.9); the risk was greatest within the first postpartum month (adjusted OR 3.6, 95% CI 0.8-16.5) .
Children's chewable vitamins with iron are less likely than adult preparations to cause serious toxicity. There were no fatalities among 195,780 exposures to chewable children's vitamins with iron reported by the American Association of Poison Control Centers between 1983 and 1998 . During the same time period, there were 60 deaths among 147,079 ingestions of adult preparations containing iron. (See 'Home management' below.)
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- Iron preparations
- Toxic dose
- Iron toxicity
- CLINICAL MANIFESTATIONS
- Gastrointestinal phase
- Latent phase
- Shock and metabolic acidosis
- Hepatotoxicity/hepatic necrosis
- Bowel obstruction
- DIFFERENTIAL DIAGNOSIS
- Physical examination
- Laboratory evaluation
- - Serum iron concentration
- Radiographic evaluation
- Deferoxamine challenge test
- Supportive care
- Risk for systemic toxicity
- GI decontamination
- - Dose and duration of treatment
- - Adverse effects
- Elimination enhancement
- Management decisions
- - Mildly symptomatic patients
- - Asymptomatic patients
- Home management
- Pitfalls in management
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS