SIL: serum iron level; WBI: whole bowel irrigation; BUN: blood urea nitrogen; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CBC: complete blood count; PT: prothrombin time; PTT: partial thromboplastin time; INR: international normalized ratio.
* For a discussion of how to calculate the toxic dose of iron, refer to UpToDate topics on iron poisoning.
¶ For information about dose and administration of deferoxamine, refer to UpToDate topics on acute iron poisoning. Consultation with a medical toxicologist and/or regional poison control center is recommended.
Δ For patients with moderate to severe iron poisoning, institution of WBI is appropriate when the number of pills seen on radiograph and the elemental iron content of the product ingested has the potential for worsening toxicity based upon patient weight (eg, 13 pills of 325 mg ferrous sulfate in a 15 kg toddler [60 mg/kg elemental iron]) or when serial serum iron concentrations continue to rise despite administration of deferoxamine.
◊ In most patients, the risk of gastric lavage following iron overdose outweighs the limited benefit. However, orogastric lavage with a large-bore orogastric tube may be indicated for patients with moderate to severe iron poisoning and large amounts of iron still unabsorbed in the stomach (eg, 20 to 30 pills). Patients who cannot protect their airway require rapid sequence intubation prior to the procedure. After lavage, a repeat abdominal radiograph should be obtained to evaluate the efficacy of gastric evacuation and determine whether further decontamination measures are necessary.