The first indication of iron poisoning occurs within the first six hours post-ingestion and involves gastrointestinal symptoms including abdominal pain accompanied by nausea and vomiting with or without blood.
Vomiting, obstruction of small intestine preventing passage of food (due to scarring) Hypovolemic shock, low blood pressure, rapid breathing, shortness of breath, tachycardia Stages of Iron Toxicity StageĪbdominal pain, diarrhea, vomiting, black stool Clinical presentation of iron poisoning in the absence of treatment progresses in five stages: the gastrointestinal phase, latent phase, metabolic acidosis and shock phase, hepatotoxicity phase, and bowel obstruction due to scarring. In serious cases, individuals may present with systemic signs and symptoms and require treatment. In mild to moderate cases, individuals may be asymptomatic or only experience mild gastrointestinal symptoms that resolve within six hours. Manifestation of iron poisoning may vary depending on the amount of iron ingested by the individual and is further classified by five stages based on timing of signs and symptoms. The degree of intervention required depends on whether the patient is at risk for serious toxicity. Treatment for iron poisoning involves providing fluid replacement, gastrointestinal decontamination, administering deferoxamine intravenously, liver transplants, and monitoring the patient's condition. The diagnosis of iron poisoning is based on clinical presentation including laboratory tests for serum iron concentrations and metabolic acidosis along with physical examination. As a response, in 1997 the US Food and Drug Administration (FDA) implemented a regulation requiring warning labels and unit dose packaging for products containing more than 30 mg of elemental iron per dose. Unintentional ingestion of iron containing drug products are a major cause of mortality in children under the age of 6 years old in the United States.
Overdoses on iron can be categorized as unintentional ingestion which is predominantly associated with children or intentional ingestion involving suicide attempts in adults. Iron is available over the counter as a single entity supplement in an iron salt form or in combination with vitamin supplements and is commonly used in the treatment of anemias. If left untreated, iron poisoning can lead to multi-organ failure resulting in permanent organ damage or death. In more severe cases, symptoms can include tachypnea, low blood pressure, seizures, or coma. Mild symptoms which occur within hours include vomiting, diarrhea, abdominal pain, and drowsiness. Iron poisoning typically occurs from ingestion of excess iron that results in acute toxicity.
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