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Acute iron poisoning

Erica L Liebelt, MD, FACMT
Section Editors
Michele M Burns, MD, MPH
Stephen J Traub, MD
Deputy Editor
James F Wiley, II, MD, MPH


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 children <12 years: Screening, prevention, clinical manifestations, and diagnosis" and "Iron requirements and iron deficiency in adolescents" and "Regulation of iron balance".)


Almost 11,000 iron exposures annually are reported in children less than six years of age in the United States [1]. The overall number of exposures in this age group decreasing. In addition, 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) [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 [6]. 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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Literature review current through: Nov 2017. | This topic last updated: May 30, 2017.
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