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Assessment of Management Guidelines

Acute Iron Ingestion

Maryland Poison Center, 20 North Pine Street, Baltimore, MD 21201

Gary M. Oderda, PharmDn MPH

Maryland Poison Center, University of Maryland School of Pharmacy

Richard L. Gorman, MD

Maryland Poison Center, University of Maryland School of Pharmacy

Fran Favin, PharmD

Maryland General Hospital, Baltimore, Maryland

S. Rutherfoord Rose, PharmD

University Hospital of Jacksonville, Jacksonville, Florida

A review of 339 treated acute iron ingestions was conducted to define treatment guidelines better. According to the poison center protocol, ingestions of 20-40 mg/kg of elemental iron required only home treatment, and ingestions of 40 mg/kg required hospital referral.

Gastrointestinal symptoms developed in 23% of patients. There were no seriously ill patients. No serious toxicity developed in patients ingesting 40-60 mg/kg. In 199 cases in which the dose ingested was known, the mean dose was 39.5 mg/kg. The peak measured serum iron levels ranged from 12 to 539 µg/dl. In 129 cases with serum iron levels reported, increasing serum iron levels were associated with vomiting (p = 0.006). Of 88 patients who received deferoxamine, 14 had urine color change. Urine color change was associated with symptoms (p = 0.005) but not with iron dose or peak serum iron level.

The poison center protocol was changed to home management for ingestions of 20-60 mg/kg unless significant symptoms developed and hospital referral for ingestions 60 mg/kg.

Clinical Pediatrics, Vol. 29, No. 6, 316-321 (1990)
DOI: 10.1177/000992289002900604


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