Iron poisoning — stages, chelation and whole bowel irrigation viva

Severity. An estimated ingestion of more than 60 mg/kg elemental iron, symptoms, hyperglycaemia above 150 mg/dL, leukocytosis above 15,000 and tablets on the radiograph indicate severe toxicity and the need for chelation.^[1] Out of hospital, a known ingestion of 40 mg/kg or more of elemental iron as adult ferrous salts warrants referral.^[2]

Phases. Five clinical phases are recognised: gastrointestinal toxicity, relative stability, circulatory shock and acidosis, hepatotoxicity, and gastrointestinal scarring.^[4]

Decontamination. There is no role for activated charcoal in iron poisoning; whole bowel irrigation was recommended for iron salts.^[5][3]

Chelation. Desferrioxamine infusion at 15 mg/kg/hour in saline; a "vin-rose" urine may help but is not seen consistently.^[1] Prolonged intravenous dosing carries pulmonary and cardiovascular toxicity, and acute respiratory distress syndrome has been linked to desferrioxamine.^[6][7]