Iron: not a benign therapeutic drug

Abstract

Purpose of review: This article reviews the pathophysiology and clinical presentation of iron poisoning. Recently proposed guidelines for triage of children with iron ingestion will be discussed as well as diagnostic and treatment modalities. Finally, the potential impact of unit-dose packaging as a primary preventative measure will be discussed.

Recent findings: Carbonyl iron has a greater safety margin than the iron salts. There have been no published reports of serious or fatal poisoning from the ingestion of carbonyl iron products. Evidence-based consensus guidelines have determined that the threshold for referral to a healthcare facility is 40 mg/kg of elemental iron in the form of adult iron formulations. Unit-dose packaging of iron preparations appeared to decrease the number of exposures to iron and deaths in the United States during the period they were instituted.

Summary: Iron poisoning remains primarily a clinical diagnosis, although certain laboratory and radiological testing may provide helpful evidence to guide evaluation and management. Primary prevention is the best modality for decreasing morbidity and mortality for all poisonings including iron.