Iron poisoning

Meet the patient

A two-year-old is found beside an open bottle of his mother's iron tablets. An hour later he vomits twice. His parents do not know how many tablets are missing.^[2]

Why this matters. From 1983 to 1991, iron caused over 30 per cent of the deaths from accidental ingestion of drug products by children.^[2] In Los Angeles in 1992–1993, five children aged 11–18 months died after ingesting iron supplement tablets.^[5] Acute iron poisoning remains a dangerous threat, particularly to children, and the evidence base rests principally on case series, expert consensus, animal studies and adult volunteer studies.^[7]

References17ShowHide

1. [1]Tenenbein M. Toxicokinetics and toxicodynamics of iron poisoning. Toxicol Lett, 1998.PMID 10022330
2. [2]Manoguerra AS, Erdman AR, Booze LL, Christianson G, Wax PM, Scharman EJ, et al. Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila), 2005.PMID 16255338
3. [3]Tenenbein M The role of whole bowel irrigation in the treatment of toxic ingestions. Br J Clin Pharmacol, 2023.PMID 36639859
4. [4]Hoegberg LCG, Shepherd G, Wood DM, et al. Systematic review on the use of activated charcoal for gastrointestinal decontamination following acute oral overdose. Clin Toxicol (Phila), 2021.PMID 34424785
5. [5]Centers for Disease Control and Prevention (CDC). Toddler deaths resulting from ingestion of iron supplements--Los Angeles, 1992-1993. MMWR Morb Mortal Wkly Rep, 1993.PMID 8429817
6. [6]Hoegberg LCG, Gosselin S, Buckley NA, et al. Recommendations from the Clinical Toxicology Recommendations Collaborative on the administration of activated charcoal in acute oral overdose. Clinical toxicology (Philadelphia, Pa.), 2026.PMID 41906697
7. [7]Chang TP, Rangan C Iron poisoning: a literature-based review of epidemiology, diagnosis, and management. Pediatric emergency care, 2011.PMID 21975503
8. [8]Mann KV, Picciotti MA, Spevack TA, et al. Management of acute iron overdose. Clinical pharmacy, 1989.PMID 2663331
9. [9]Tenenbein M Benefits of parenteral deferoxamine for acute iron poisoning. Journal of toxicology. Clinical toxicology, 1996.PMID 8800185
10. [10]Howland MA Risks of parenteral deferoxamine for acute iron poisoning. Journal of toxicology. Clinical toxicology, 1996.PMID 8800186
11. [11]Chyka PA, Butler AY, Holley JE Serum iron concentrations and symptoms of acute iron poisoning in children. Pharmacotherapy, 1996.PMID 8947978
12. [12]Everson GW, Oudjhane K, Young LW, et al. Effectiveness of abdominal radiographs in visualizing chewable iron supplements following overdose. The American journal of emergency medicine, 1989.PMID 2757710
13. [13]Ioannides AS, Panisello JM Acute respiratory distress syndrome in children with acute iron poisoning: the role of intravenous desferrioxamine. European journal of pediatrics, 2000.PMID 10664227
14. [14]Tran T, Wax JR, Philput C, et al. Intentional iron overdose in pregnancy--management and outcome. The Journal of emergency medicine, 2000.PMID 10699527
15. [15]McElhatton PR, Roberts JC, Sullivan FM The consequences of iron overdose and its treatment with desferrioxamine in pregnancy. Human & experimental toxicology, 1991.PMID 1679648
16. [16]Siff JE, Meldon SW, Tomassoni AJ Usefulness of the total iron binding capacity in the evaluation and treatment of acute iron overdose. Annals of emergency medicine, 1999.PMID 9867890
17. [17]Baranwal AK, Singhi SC Acute iron poisoning: management guidelines. Indian pediatrics, 2003.PMID 12824662