Toxicology: Iron

Iron poisoning can be deceptive. Early symptoms can look like routine gastroenteritis, children may appear to improve during a latent phase, and significant toxicity can progress to metabolic acidosis, shock, and hepatic injury. In this episode of PEM Currents, we review the recognition and management of pediatric iron toxicity, including when to obtain a serum iron level, the role of abdominal radiographs and whole bowel irrigation, indications for deferoxamine, and disposition.

Learning Objectives

After listening to this episode, learners should be able to:

Recognize the clinical stages of pediatric iron toxicity and identify features concerning for significant systemic toxicity.

Use the estimated elemental iron dose, serum iron concentration, and abdominal radiography to evaluate a child with a suspected iron ingestion.

Describe the emergency management of iron toxicity, including supportive care, whole bowel irrigation, indications for deferoxamine, and appropriate disposition.

References

Manoguerra AS, Erdman AR, Booze LL, et al. Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(6):553-570.

Halil H, Tuygun N, Polat E, Karacan CD. Minimum ingested iron cut-off triggering serious iron toxicity in children. Pediatr Int. 2019;61(5):444-448.

Klein-Schwartz W, Oderda GM, Gorman RL, Favin F, Rose SR. Assessment of management guidelines: acute iron ingestion. Clin Pediatr (Phila). 1990;29(6):316-321.

Banner W Jr, Tong TG. Iron poisoning. Pediatr Clin North Am. 1986;33(2):393-409.

Script