Acute Iron Toxicity Management

Acute iron toxicity arises when excessive elemental iron is ingested, leading to mucosal injury, systemic absorption of free iron and generation of reactive oxygen species. Clinical presentation evolves through distinct phases: initial gastrointestinal irritation with vomiting and diarrhoea, a deceptive latent period, systemic collapse marked by hypotension and metabolic acidosis, and, in severe cases, fulminant hepatic failure. Prompt assessment of serum iron concentration at four to six hours post-ingestion guides the need for intervention. Decontamination strategies include whole bowel irrigation and, in specific scenarios, activated charcoal. Definitive therapy centres on chelation, most commonly with deferoxamine, to bind circulating iron and facilitate renal excretion. Supportive measures encompass haemodynamic stabilisation, correction of acid–base disturbances and monitoring for coagulopathy and organ dysfunction. In refractory cases of fulminant hepatic injury, liver transplantation may be life-saving. Management protocols emphasise individualised decision-making based on clinical status rather than reliance on laboratory thresholds alone, ensuring that treatment is tailored to the evolving toxicodynamic profile of each patient.

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Acute Iron Toxicity Management publication trend

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Technical terms

Chelation therapy: Use of chemical agents to bind free iron and facilitate its elimination via the kidneys.

Deferoxamine: A synthetic iron-chelating agent administered parenterally to form water-soluble complexes excreted in urine.

Activated charcoal: Finely divided carbon with high adsorptive capacity, used orally to sequester ingested toxins in the gut.

Whole bowel irrigation: Administration of large volumes of iso-osmotic fluid to flush unabsorbed substances from the gastrointestinal tract.

Serum iron concentration: The measured level of circulating iron in the blood, used to assess severity of poisoning.

Fulminant hepatic failure: Rapid onset of severe liver dysfunction characterised by coagulopathy and encephalopathy.

References

1. Intravenous iron overdose: treat the patient not the number. Toxicology Communications (2019).
2. Management of Acute Ferrous Sulfate Poisoning Using Activated Charcoal Monotherapy: A Case Report. Cureus (2023).
3. Ingestion of Toxic Iron Dose With Benign Outcome. Cureus (2023).
4. Liver Transplantation for Acute Hepatic Failure Following Intentional Iron Overdose. Cureus (2023).