![]() The nephrologist should be consulted in case dialysis is required. The nurses should be fully aware of the potential toxicity of iron and closely monitor the patient. Patients with hemodynamic instability should be admitted to the ICU. The use of the chelating agent, deferoxamine may be used in severe cases of metabolic acidosis. The acute toxicity requires reversal of the hypotension and hypovolemia. The management of patients with iron toxicity is usually done with an interprofessional team that includes the emergency department physician, poison control specialist, internist, intensivist, nurse practitioner, pharmacist, and a hematologist. Iron toxicity has significant morbidity and mortality. In adults, the cause may be suicide or chronic blood transfusions. The key reason why children overdose on iron tablets is because they appear as chocolate candy. Iron poisoning is commonly seen in the emergency room. However, there is no correlation between radiopacities on x-rays and the severity of poisoning. One may be able to see the pills on the KUB film. X-rays may show the radiopaque iron tablets for 2-6 hours post-ingestion. ![]() Normal radiographs do not exclude iron ingestion. Plain radiographs may reveal iron in the GI tract, but many iron preparations are not radiopaque. Other laboratory tests include electrolytes, kidney function, serum glucose, coagulation studies, complete blood count, and liver function. Therefore, the iron level drawn after ingestion may be deceptively low if measured after its peak. Iron is rapidly cleared from the serum and deposited in the liver. Levels above 500 micrograms/dL are associated with severe systemic toxicity. Levels between 350 to 500 micrograms/dL are associated with moderate toxicity. ![]() Peak serum iron levels below 350 micrograms/dL are associated with minimal toxicity. Sustained-release or enteric-coated preparation may have erratic absorption, and therefore a second level 6 to 8 hours post-ingestion should be checked. A serum iron level measured at its peak, 4 to 6 hours after ingestion, is the most useful laboratory test. Serum iron levels are used to determine a patient’s potential for toxicity. The diagnosis of iron toxicity is based on the history and clinical presentation.
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